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Predicting Severe Diabetes Complications Using Administrative Claims Data in Maryland

Predictive risk scores created using administrative claims and publicly available social determinants of health data strongly predicted severe diabetes complications for Maryland Medicare fee-for-service beneficiaries.

Racial and Ethnic Disparities in Telemental Health Use Among Publicly Insured Children

Among publicly insured children with mental health–related encounters, racial and ethnic disparities in telemental health use widened following the onset of the COVID-19 pandemic.

Navigating Sport-Related Neurospine Injuries, Surgery, and Managed Care

On this episode of Managed Care Cast, we speak with Arthur L. Jenkins III, MD, FACS, CEO of Jenkins NeuroSpine, to explore the intersection of advanced surgical care for sport-related neurospine injuries and managed care systems.

Avoiding Surgical Resection of Recurrent BRAF V600E–Mutated Iodine-Refractory Papillary Thyroid Cancer Involving Trachea/Thyroid Cartilage via Resensitization With Dabrafenib and Trametinib: Report of 3 Cases

Hospital Participation in Medicare ACOs: No Change in Admission Practices and Spending

Hospital accountable care organization (ACO) participation did not impact emergency department admission rates, length of stay, or costs, suggesting limited effectiveness in reducing spending for unplanned admissions and challenging hospital-led ACO cost-saving strategies.

Health-Related Social Needs, Methods, and Concerns for a Polysocial Risk Score: An Expert Panel

A polysocial risk score is a potentially useful addition to the growing methodologies to better understand and address health-related social needs.

Impact of an Intensive Outpatient Clinic Model on Health Care Utilization and Cost

An intensive outpatient clinic model significantly reduced health care spending, hospital admissions, and emergency department visits among complex Medicaid patients over a 2-year period.

The Cost of Implementing and Sustaining the Massachusetts Model

This article presents a microcosting analysis of resources needed for the implementation and sustainment of the Massachusetts model evaluated in the PROUD trial.

From Complexity to Clarity: A Path to Value in Employer Health Plans

Employers struggle to define value from health care spending amid complexity and misaligned incentives. Achieving measurable outcomes requires transparency, incentive realignment, and gradual, employee-centered change.

Health Care Utilization in Veterans With Alzheimer Disease

Veterans with Alzheimer disease (AD), identified using clinical notes, have higher health care utilization than veterans without AD.

Building Trust: Public Priorities for Health Care AI Labeling

A Michigan-based deliberative study found strong public support for patient-informed artificial intelligence (AI) labeling in health care, emphasizing transparency, privacy, equity, and safety to build trust.

High-Intensity Home-Based Rehabilitation in a Medicare Accountable Care Organization

High-intensity home-based rehabilitation (HIHR) may substitute for facility-based postacute rehabilitation. Patients in HIHR had better functional outcomes at lower costs than patients in facility-based care.

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.

The Impact of Health Benefit Design on Patients With Infertility

This retrospective analysis explored the impact of infertility health benefit design on the use of infertility medications and procedures and pregnancy 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.

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.

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.

RAISE: Elevating Person-Centered Data for Healthy Communities

The RAISE program provides awareness and shares comprehensive solutions to address the multifaceted reasons for missing and incomplete data across the real-world data continuum.

Actions to Improve Quality: Results From a National Hospital Survey

Hospitals reported widespread adoption of quality improvement (QI) changes to improve on CMS quality measures, and QI adoption was associated with improved performance on quality measures.

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.

Bridging Boundaries: A Research Consortium to Advance Hospital-at-Home Care Delivery

As the hospital-at-home model grows, a consortium is needed to advance scalability, equity, caregiver well-being, and cost efficiency through research and collaboration.

Real-World Weight Loss With Injectable Semaglutide vs Dulaglutide for Diabetes

In this real-world study of patients with type 2 diabetes, treatment with semaglutide resulted in greater reductions in body weight and hemoglobin A1c than dulaglutide.

Health Impacts of Health System Implementation of a Food-as-Medicine Strategy

This article describes the reach of a Food-as-Medicine strategy implemented by a regional health care system and its impact on adult participants’ cardiometabolic risk factors.

Evaluation of Institutional Practices for Medication Access for Uninsured Patients

The authors assessed charitable care spending for a 1-month supply of medications at discharge. One-third of the cost was spent on medications for which a more sustainable coverage method exists.

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.

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.

Insurers Cut 11% of Prior Authorizations, Expand Continuity-of-Care Protections

Major health plans cut millions of preapproval hurdles, add 90-day continuity protections, and push real-time e-authorization to speed care access.

KAP Regarding ChatGPT Among Health Care Professionals: Correspondence

This letter discusses previously published research that paves the way for deeper exploration of the ethical and human aspects of artificial intelligence in health care.

Physiologic Insulin Resensitization Lowers Cost in Patients With Diabetes and Kidney Disease

Patients with diabetes and chronic kidney disease receiving physiologic insulin resensitization had much lower annual costs of care than similar patients not receiving it.

Female Patients With ILD Show Lower ICU Mortality Rates: Matthew Viggiano, MD

Matthew Viggiano, MD, internal medicine resident, Temple University Hospital, shares findings on a study in which female patients with interstitial lung disease (ILD) admitted to the intensive care unit (ICU) experienced significantly lower mortality rates and shorter hospital stays than male patients with ILD.