Authors

Prior Authorization Requirements in Medicare Advantage and County Social Vulnerability

This study links county-level social vulnerability to variation in Medicare Advantage prior authorization policies.

Association of Opioid Utilization Management With Prescribing and Overdose

Opioid utilization management in Medicare was associated with mixed effects on opioid prescribing, and prior authorization was associated with a decreased likelihood of subsequent overdose.

UPMC Health Plan's Food as Medicine Pilot for Members With Diabetes

The pilot pairs grocery stipends and community health worker support with members who have unmanaged diabetes and unmet social needs.

Idiopathic Pulmonary Fibrosis: Exploring the Clinical and Economic Implications of the Evolving Treatment Landscape

Subjective and Objective Impacts of Ambulatory AI Scribes

Although the vast majority of physicians using an artificial intelligence (AI) scribe perceived a reduction in documentation time, those with the most actual time savings had higher relative baseline levels of documentation time.

Chronic Disease Management: Why Dementia Care Is Different

Because of its often slowly progressive nature, dementia is often included among chronic disease management programs. Yet, for many reasons, its management demands different approaches.

Benefit Design and Consumer Information: Results From a Randomized Trial

Findings from a randomized controlled trial on reducing information barriers for consumers selecting primary care clinics in a tiered network design demonstrate limited marginal effect of the intervention.

Interventional Analytics in Skilled Nursing Facilities Associated With Reduced Readmissions

A retrospective analysis of 30-day risk-adjusted readmission rates among skilled nursing facilities (SNFs) between 2017 and 2022 compared those that had implemented an interventional analytics platform and other SNFs.

Managed Care Reflections: A Q&A With Dora Hughes, MD, MPH

To mark the 30th anniversary of The American Journal of Managed Care, each issue in 2025 includes a special feature: reflections from a thought leader on what has changed—and what has not—over the past 3 decades and what’s next for managed care. The September issue features a conversation with Dora Hughes, MD, MPH, chief medical officer and director of the Center for Clinical Standards and Quality at CMS.

Association of Physician Coordination With Interfacility Transfer Acceptance Timeliness

The authors reviewed physician-to-physician conversations during emergency transfer of patients with ST-segment elevation myocardial infarction and found that higher-quality physician coordination was associated with faster time to acceptance.

Relationships Between Patient Portal Activation and Patient Satisfaction Scores Among CG-CAHPS and HCAHPS Respondents

Patients with activated patient portal accounts report higher patient satisfaction in respective dimensions of the Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) and Hospital CAHPS (HCAHPS) surveys compared with patients without portal accounts.

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.

Filling the Gaps in Guideline-Directed Care

ASCO GI 2026 Recap: Breakthroughs, Community at the Forefront of Gastrointestinal Cancer Research

Presenters shared their personal highlights of attending ASCO GI 2026.

Physician-Pharmacy Integration in Cancer Care: Pillars of Medically Integrated Pharmacy

The foundation of medically integrated pharmacy includes 7 critical pillars. This commentary focuses on the benefits of 3 of those pillars: abandonment, adherence, and access/affordability.

Changes in Persistence to Basal Insulin Following the Medicare Out-of-Pocket Cost Cap

The authors evaluated changes in persistence to basal insulin in a Medicare Advantage population in the first year of the Medicare insulin out-of-pocket cost cap.

Evaluating Proactive Outreach for Prior Authorization Recertifications in Medicaid Patients

Implementing a proactive provider outreach program resulted in significantly more prior authorization recertifications and a reduction in time to submission.

Real-world Usage of Bevacizumab-bvzr Biosimilar in US Oncology Practice

Real-world adoption of bevacizumab-bvzr biosimilar was retrospectively assessed, revealing switching between biosimilars and the reference product and utilization in extrapolated indications and combination regimens.

Community Health Workers’ Critical Role in Trust Building Between the Medical System and Communities of Color

The authors interrogate elements of routine medical practice in New York City to argue for reforms of hospital culture through relational trust-building capabilities of community health workers.

Modeling the Economic Value of Cardiometabolic Virtual-First Care Programs

Using a microsimulation approach, this study modeled the potential multiyear health and economic benefits of participating in cardiometabolic virtual-first care programs.

Development and Validation of the COVID-19 Hospitalized Patient Deterioration Index

The authors developed and validated an accurate, well-calibrated, easy-to-implement COVID-19 hospitalized patient deterioration index to identify patients at high or low risk of clinical deterioration.

Real-World Users of Triple Therapy for Asthma in the US

This retrospective cohort study evaluated baseline demographics, clinical characteristics, and treatment patterns of US patients with asthma who newly initiated single- or multiple-inhaler triple therapy.

Adverse Drug Effects Across Patients With Heart Failure: A Systematic Review

This systematic literature review reports incidence of adverse drug effects associated with guideline-directed medical therapy for patients with heart failure with reduced ejection fraction.

Association of Co-pay Elimination With Medication Adherence and Total Cost

This study evaluated cost and utilization attributed to members enrolled in a health care program with no pharmacy co-pay. Health care savings were identified in addition to medication adherence improvements.

Effects of a Schizophrenia Pay-for-Performance Program on Health Care Resource Utilization

A pay-for-performance program reduced outpatient visits among patients with schizophrenia but did not affect emergency department visits, hospital admissions, or length of stay.

An Outpatient Critical Care Transition Clinic Model Reduces Admissions/Readmissions in Medically Complex Patients

Critical care transition clinic patients with chronic conditions had a 31% reduction in relative risk for inpatient admissions, and the clinic reduced cost by more than $1 million.

Facilitators of and Barriers to Medicaid Investment in Electronic Consultation Services

In this qualitative investigation, leaders of Medicaid managed care plans were interviewed to identify facilitators of and barriers to electronic consultation for specialty care delivery.

Bridging the Gap Between Medical and Pharmacy Benefits

As health care costs rise, especially for patients with complex conditions, a major barrier to access is the disconnect between medical benefits and pharmacy benefits.

Medication Adherence Star Ratings Measures, Health Care Resource Utilization, and Cost

For patients prescribed diabetes, hypertension, and hyperlipidemia medications, nonadherence to CMS Star Ratings quality measures of medication adherence was associated with increased health care resource utilization and costs.

Primary Care Redesign and Care Fragmentation Among Medicare Beneficiaries

This article examines the association between a large-scale primary care redesign—the Comprehensive Primary Care Plus Initiative—and ambulatory care patterns of Medicare beneficiaries with highly fragmented care.