Authors

Effects of Adjunctive Cariprazine Formulary Restrictions in Major Depressive Disorder

Patients who experienced a formulary-related rejection of cariprazine for adjunctive treatment of major depressive disorder had significantly higher hospitalization rates than those with approved claims.

Roles and Priorities Guiding Medicare Advantage Postacute Home Health Referrals

This study examines how key players in managed care drive postacute home health referrals, identifying tensions, limited patient involvement, and barriers to care coordination.

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.

Evaluating Access to Care for Medicare Beneficiaries Younger Than 65 Years

Enrollment in Medicare coverage without out-of-pocket protections was associated with a higher likelihood of reporting cost and access barriers to care.

Health Outcomes of Socially Vulnerable Populations in Different Medicare Payment Arrangements

Beneficiaries in socially vulnerable communities received higher-quality, more-efficient care under value-based care (at-risk Medicare Advantage) compared with those in fee-for-service Medicare payment arrangements.

Hospitalization Patterns Among Older Patients With Cancer With and Without Dementia

Dementia was more prevalent in older patients with some cancer types, and comorbid dementia in this population was associated with unplanned or unnecessary hospitalization.

Review of the Clinical, Humanistic, and Economic Burden of Focal Segmental Glomerulosclerosis

Utilization by High-Cost, High-Need Medicaid Patients Receiving Social Worker Care Coordination

Complex Medicaid patients randomly assigned to receive outpatient social worker care coordination services experienced increased hospitalizations but no differences in emergency department visits or costs.

Enhancing NSCLC Brain Metastasis Treatment With MR-Guided Ultrasound: Manmeet Ahluwalia, MD, MBA, FASCO

Manmeet Ahluwalia, MD, MBA, FASCO, chief of medical oncology, chief scientific officer, and deputy director of the Miami Cancer Institute of Baptist Health South Florida, discusses a groundbreaking clinical trial for non-small cell lung cancer (NSCLC) brain metastases.

Medical Policy Determinations for Pharmacogenetic Tests Among US Health Plans

This analysis demonstrated significant variability in medical policy determinations and evidence cited for clinically relevant pharmacogenetic tests among major US health insurers and laboratory benefit managers.

Medical Policy Determinations for Pharmacogenetic Tests Among US Health Plans

This analysis demonstrated significant variability in medical policy determinations and evidence cited for clinically relevant pharmacogenetic tests among major US health insurers and laboratory benefit managers.

Telemedicine Utilization and Preventive Services Among a Rural Population

Telemedicine use in rural areas was associated with a higher likelihood of utilizing preventive services.

Effect of Remote Patient Monitoring on Stage 2 Hypertension

A community-based remote patient monitoring (RPM) program was associated with significant reduction in blood pressure in Medicare patients with stage 2 hypertension, highlighting the potential benefits of RPM with care coaching.

rVWF Safely, Effectively Manages Perioperative Bleeding in Pediatric Patients: Shayla Bergmann, MD

Shayla Bergmann, MD, explains that recombinant von Willebrand factor is both safe and highly effective in controlling perioperative bleeding in children with severe von Willebrand disease.

Inflation Reduction Act Impact on the Hematology/Oncology Treatment Landscape

The Inflation Reduction Act introduced Medicare drug price negotiations to reduce treatment costs, enhance access, and potentially reshape prescribing patterns in oncology and hematology.

More Employers Offer Preventive Drug Lists Over Time

More large employers with high-deductible health plans with health savings accounts offer preventive drug list benefits over time.

Regulating Private Equity in Health Care: A Strategic Policy Agenda

Private equity’s growing influence on American health care has outpaced regulatory oversight. Stronger policies are necessary to safeguard patients, providers, and care delivery.

Prevalence, Resource Utilization, and Economic Impact of Kidney Function and Proteinuria in Patients With Focal Segmental Glomerulosclerosis

Assessing Evidence for MTM Quality Measure Development: A Scoping Review

Quality evidence is needed to support a new Medicare Part D medication therapy management (MTM) program performance measure, prompting a scoping review on MTM services and associated outcomes.

Regulating Private Equity in Health Care: A Strategic Policy Agenda

Private equity’s growing influence on American health care has outpaced regulatory oversight. Stronger policies are necessary to safeguard patients, providers, and care delivery.

EHR-Based Machine Learning Models Outperform STOP-BANG for OSA Screening: Nathanael Hwang

Nathanael Hwang discusses how EHR-based machine learning models are adding value to patients with obstructive sleep apnea.

Objective Predictors of Financial Toxicity in Oncology

Relationship Between Medication Adherence and Other Medicare Star Rating Measures

Performance on Medicare Star Ratings medication adherence measures is significantly tied to performance on the intermediate outcome and statin process measures.

Addressing STIs Through Managed Care: Opportunities in Medicaid and Beyond

Medicaid and other managed care organizations could take several key steps to respond to the sexually transmitted infection (STI) epidemic in the US, including congenital syphilis.

Cost-Effectiveness of Implementing a Home Blood Pressure Telemonitoring Program

A home blood pressure telemonitoring program effectively reduced blood pressure in real-world clinical settings, but program enrollment expenses increased overall costs.

Integrated Care for Chronic Conditions: A Randomized Care Management Trial

The authors sought to understand the differential impact of payer-led community-based care management approaches on stakeholder-oriented outcomes for publicly insured adults with multiple chronic conditions.

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.