Authors

Study Finds Flaw in Method for Key Oncology Value-Based Care Model

McKesson and The US Oncology Network find EOM attribution often mislabels cancer episodes—especially oral therapy—threatening value-based care accuracy and accountability.

Do Localized Disasters Impact Clinical Measures of Health Care Quality?

This study examines the impact of geographically limited disasters on health care quality performance scores of Medicare Advantage contracts, finding limited impact on performance scores.

Quality of Life: The Pending Outcome in Idiopathic Pulmonary Fibrosis

Because evidence gaps in idiopathic pulmonary fibrosis research hinder demonstration of antifibrotic therapies’ impact on patient quality of life (QOL), integrating validated health-related QOL measures into trials is urgently needed.

Preventing Tomorrow’s High-Cost Claims: The Rising-Risk Patient Opportunity in Medicaid

For Medicaid care management, focusing on rising-risk patients is more effective than targeting high-cost claimants, whose spending tends to decrease over time due to regression to the mean.

Effects of Individualized Nurse-Led Care Plans on Olaparib Treatment Duration

A nurse-led personalized care program conducted through a specialty pharmacy prolonged medication persistence among patients with cancer receiving olaparib.

Frequent Primary Care Visits May Lower Costs for Higher-Risk Commercially Insured Adults

Tory M. Wolff, MBA, discusses his study showing that frequent routine primary care visits may lower costs for higher-risk commercially insured adults.

To Expand Access to Cancer Expertise, Collaboration Is Key

Effects of Maryland’s All-Payer Model on Elective Joint Replacement Surgery

The Maryland All-Payer Model was associated with an increase in population-based rates of elective major joint replacements, with a more pronounced effect observed in Maryland-only hospitals.

Varied Access: The Pharmacogenetic Testing Coverage Divide

On this episode of Managed Care Cast, we speak with the author of a study published in the February 2025 issue of The American Journal of Managed Care® to uncover significant differences in coverage decisions for pharmacogenetic tests across major US health insurers.

Prevalence and Inclusiveness of Pay-for-Performance Incentives for HPV Vaccination

This article examines the prevalence of pay-for-performance incentives to promote human papillomavirus vaccination and other quality metrics as reported by frontline clinical staff.

Outcomes in Patients With IBD Stratified by Risk of Disease Progression

This study validates criteria to identify patients with inflammatory bowel disease (IBD) at risk of worsening disease who may benefit from early treatment with advanced therapies.

Participating Factulty: Real-World Impact of Infliximab Precision-Guided Dosing on Management of Patients With IBD

Managed Care COVID-19 Outcomes in a Population Health Program

Data from 38,193 patients showed that managed care patients have COVID-19 risk factors similar to those of the general population and that a population health program decreased mortality.

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.

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.

Cost-Effectiveness of a Multicancer Early Detection Test in the US

Multicancer early detection testing results in extended life-years and reduced cancer treatment costs through earlier diagnosis, leading to a cost-effective option in cancer screening.

Clinical Outcomes in Heart Failure Monitoring: A Pooled Rates Analysis

This systematic literature review and pooled rates analysis investigated the standard of care for patients with heart failure in the US post hospital discharge.

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.

An Integrated Practice Unit Tool for the Military Health System

Researchers developed and tested an assessment tool to measure coordinated care for traumatic brain injury against the criteria of an integrated practice unit.

Disparities in Physician Access for Rheumatology, Dermatology, and Gastroenterology: A Systematic Review

This article presents a systematic review of US health care disparities in physician specialist access across rheumatology, dermatology, and gastroenterology and a call to action.

AI Cannot Fix a Broken Claims Paradigm

This article provides a commentary on a news feature published on AJMC.com in 2025 titled “AI Seen as Key to Reducing Health Care Claim Denials, Survey Finds.”

Interventions Addressing Cost-Related Medication Nonadherence in Diabetes: A Scoping Review

Many US patients with diabetes cannot afford their medical care. The authors review the impact of interventions that reduced and/or eliminated diabetes-related costs.

Cash and Commercial Negotiated Prices of Physician-Administered Drugs in US Hospitals

Using nationally representative data, the authors found that for common physician-administered drugs, hospitals’ unilaterally set cash prices are frequently lower than their median—and sometimes even their lowest—commercial negotiated prices.

Amivantamab Plus Chemotherapy Delivers Durable Responses in RAS/BRAF Wild-Type mCRC: Filippo Pietrantonio, MD

Filippo Pietrantonio, MD, discusses findings from the phase 1/2 OrigAMI-1 study in RAS/BRAF wild-type mCRC.

AI-Screening for Diabetic Retinopathy in Primary Care

AI-based diabetic retinopathy screening in primary care meaningfully lowers overall health care costs compared with physician-referral screening.

Temporal Shift in Prevalence of Heart Failure Diagnoses and Comorbidities Within 2 US Integrated Health Systems

The analysis highlighted a shift in heart failure diagnoses, with hypertensive heart disease with and without chronic kidney disease as prevalent diagnoses, underlining coding variability and implications for research.

Insights Into Patient Portal Engagement Leveraging Observational Electronic Health Data

This analysis of more than 250,000 adults at least 50 years old with chronic conditions showed lower portal use among older, non–English-speaking, and Black patients, underscoring digital health equity gaps.

Medicare Accountable Care Organizations: Clinical Performance for Patients With Heart Failure

Higher-performing Medicare accountable care organizations are smaller and characterized by real-time information sharing, regular performance feedback, primary care physician leaders, physician buy-in, and strong care management programs.

Linking Insured Adults to Behavioral Health Care: A Cost-Saving Solution

Connecting primary care providers and commercially insured adults to outpatient behavioral health services via a digital platform improved health outcomes and reduced medical costs.