Authors

Challenges Faced by Medicaid Managed Care Coordinators Working With Members With Substance Use Disorder

Accessing medical and social resources for patients, heavy administrative burden, and lack of data integration are barriers to Medicaid managed care organization care coordinators’ job performance.

Reducing Readmissions in the Safety Net Through AI and Automation

Artificial intelligence (AI) and electronic health record–based automation tools helped a safety-net health system meet performance-based readmission metrics, thereby retaining critical funding while improving clinical and equity outcomes.

Gaps in the Coordination of Care for Older Adults With or at Risk for Cardiovascular Disease

Older adults with cardiovascular disease (CVD) or CVD risk factors report that gaps in communication among their providers are common and hazardous.

Development of Multipayer Claims-Based Emergency Department Episodes of Care

Thirty-day episodes of care initialized by emergency department visits can inform future quality improvement efforts.

Specialty and Operator Status Influence Electronic Health Record Use Variation

Operators demonstrated specialty-specific differences in electronic health record efficiency, timeliness, and after-hours use, highlighting how workflow and training shape documentation behaviors across medical disciplines.

Impact of Telemedicine Use on Outpatient-Related CO2 Emissions: Estimate From a National Cohort

Telemedicine was associated with a monthly avoidance of greenhouse gas emissions equivalent to the emissions of 61,255 to 130,076 passenger vehicles.

Price Transparency With Gaps: Assessing the Completeness of Payer Transparency in Coverage Data

In analyzing 2025 Transparency in Coverage (TIC) files from national insurers, the authors found vast payer-level differences; overall, physician/outpatient data were more complete, and hospital inpatient data were less complete.

Affordable Care Act Enrollment in Texas After Rating Area Adjustments

Rural marketplace rating area change in Texas did not increase enrollment but increased share of enrollment in gold plans.

State Sanctions May Not Affect Medicaid Managed Care

One in 4 Medicaid managed care organization sanctions are not remediated, revealing inconsistent state and federal oversight and the need to standardize CMS reporting and enforcement guidelines.

The Role of Advanced Technologies in Improving Diabetes Outcomes

This article reviews underlying barriers to health care access and discusses how a value-based diabetes care model could improve patient outcomes and reduce long-term costs.

Impact of COVID-19 on Specialty Televisits in a Large Integrated Health Care System

Specialty televisits remain common in the Veterans Health Administration following the COVID-19 pandemic, suggesting they will remain an important ongoing care modality for many patients.

Reflecting on Global Pulmonary Medicine Insights at ATS 2025

Attendees at the American Thoracic Society (ATS) 2025 International Conference highlight global networking, scientific advancements, and professional development at this year's meeting.

First-Time Medicare Advantage Enrollees Demonstrate Increasing Demographic and Clinical Diversity

As Medicare Advantage grows, first-time enrollees demonstrate increasing demographic and clinical diversity, indicating that benefits should be designed to reflect the population’s changing composition.

Medicare Expenditures in the First Year of Amyotrophic Lateral Sclerosis Diagnosis

Medicare expenditures for patients with amyotrophic lateral sclerosis are more than 3 times those of the average Medicare beneficiary, and drug therapies are an important cost driver.

Factors That Increase Utilization Management Risk: A Proof of Concept

A score was developed to measure patient risk from payer utilization management policies and its relationship to real-world US commercial payer utilization management policies.

Insurance-Provided Grocery Assistance and Health Care Outcomes Among Patients With Diabetes

Receipt of an insurer-provided grocery benefit was associated with decreased rates of diabetes with complications and increased medication adherence among a population with diabetes.

Treatment Burdens in Traditional Medicare and Medicare Advantage

Most Medicare beneficiaries perceived low health care burdens, but 1 in 4 Medicare Advantage enrollees with at least 6 chronic conditions experienced high administrative and financial burdens.

GLP-1 Receptor Agonists: Trend, Necessity, or Blessing?

Glucagon-like peptide 1 (GLP-1) receptor agonists offer promise in weight and cardiovascular risk reduction, but their use must complement—not replace—lifestyle interventions within a holistic, patient-centered care model.

Initiation of the Interchangeable Biosimilar Insulin Glargine-yfgn Among Older Adults

Initiators of biosimilar insulin glargine-yfgn were more likely to reside in rural areas, live in long-term care facilities, or have multiple prescribers and were less likely to have previously used an originator insulin glargine product.

Insurance Payer Is Associated With Length of Stay After Traumatic Brain Injury

Among hospitalized patients with traumatic brain injury, Medicaid fee-for-service was associated with longer hospital stays than private insurance and Medicaid managed care organizations.

Clinical Setting of Initial Psychotic Spectrum Disorder Diagnoses in an Integrated Health System

This study examines the clinical settings of first-time psychotic spectrum disorder diagnoses in an integrated health system.

A Health Economic Evaluation of Digital Digestive Care Management

Chronic gastrointestinal disorders are common and costly for employers. Use of a digital digestive care program was associated with reduced health care spending.

Updated Clinical Guidelines Outline Optimal Treatment of Helicobacter pylori Infection

For pharmacists wondering whether bismuth quadruple therapy still reigns as the gold standard, the wait is over—the latest recommendations are here.

Impact of Hospital-Physician Integration on Medicare Patient Mix

This study found no evidence that hospital employment of physicians resulted in physicians treating sicker patients, undercutting claims that hospital-employed physicians serve a higher-acuity patient mix.

Determinants of Hospital Charges and Costs in Acute Myocardial Infarction: A Report from the Myocardial Infarction Cost Study (MICS) Group

Association Between Screening for Suspected COVID-19 Cases and Outcomes of Patients Revisiting the Emergency Department

Patients who revisit the emergency department shortly after discharge are at high risk for complications and death, exacerbated by COVID-19 screening workload. Detection efforts impact outcomes.

Service Utilization by High-Need, High-Cost Patients Following Emergency Department Visits

This article provides insights into patterns of health care use following emergency department visits by high-need, high-cost patients with different types of California Medicaid primary care providers.

Why ASCO Is a Must-Attend Event for Oncologists Worldwide

Leaders in oncology share why the American Society of Clinical Oncology (ASCO) meeting remains a top global gathering for breakthroughs, networking, and lifelong learning.

Predictive Models for Low Birth Weight: A Comparative Analysis of Algorithmic Fairness–Improving Approaches

This study compared 6 algorithmic fairness–improving approaches for low-birth-weight predictive models and found that they improved accuracy but decreased sensitivity for Black populations.

Industry Payments to Cardiologists Are Associated With Higher Medicare Spending

This study of 26,805 cardiologists shows that industry payments (averaging $3958) are linked to increased Medicare costs, with each $10,000 in payment associated with $14.1 higher beneficiary spending.