Authors

Contributor: Employers Are Turning to Virtual Care Options to Mitigate Costs

Virtual care not only means saved time and costs for employees, but improvements to employers' bottom lines, through more proactive management of health concerns, notes UCM Digital Health CEO and co-founder Keith Algozzine.

Clinical and Economic Outcomes of a Collaborative Cardiology Care Program

Patients with chronic cardiac conditions benefited from a health care program that strengthened collaboration between general practitioners and cardiology specialists in Baden-Wuerttemberg, Germany.

Statin Prescribing Patterns in Patient-Centered Medical Home Patients With NAFLD

In this study, authors assessed the proportion of patients with nonalcoholic fatty liver disease (NAFLD) receiving prescriptions for statins in primary care.

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.

Remote Monitoring Saves Costs in Outpatient Negative Pressure Wound Therapy

Health insurance records of patients using negative pressure wound therapy (NPWT) revealed lower adjusted 90-day wound-related costs with remote therapy monitoring vs NPWT alone.

An Analysis of Medicare Accountable Care Organization Expense Reports

The authors of this study examined expense reports to understand how participants in Medicare’s Accountable Care Organization Investment Model spent to achieve program goals.

Out-of-Pocket Costs for Diabetes Medications in Employer-Sponsored Health Insurance Plans

Out-of-pocket costs of diabetes medications other than insulin can be quite high for individuals with employer-sponsored health insurance.

ACA Dependent Coverage Extension and Young Adults’ Substance-Associated ED Visits

This study examines the impact of the Affordable Care Act (ACA) on substance-associated emergency department (ED) visits among young adults, revealing reduced alcohol-associated visits but unchanged opioid-associated visits.

Impact of Food Affordability on Diabetes-Related Preventable Hospitalization

Medicaid enrollees residing in counties with greater food affordability had lower odds of preventable hospitalization related to diabetes.

Prior Authorization Requirements for Calcitonin Gene-Related Peptide Antagonists

This quantitative and qualitative analysis highlights differences in prior authorization requirements for migraine drugs from nearly 50 managed care organizations and summarizes broad types of criteria used.

Care Quality Metrics in Medicare During COVID-19 Pandemic

Medicare Advantage outperformed traditional Medicare on clinical quality measures before and during the COVID-19 pandemic; mid-pandemic, however, traditional Medicare narrowed the gap on some in-person screenings.

Primary Care Visit Cadence and Hospital Admissions in High-Risk Patients

Patients with congestive heart failure and/or chronic obstructive pulmonary disease who had more quarterly primary care visits had lower rates of hospitalizations during the COVID-19 pandemic.

Scaling Care Coordination Through Digital Engagement: Stepped-Wedge Trial Assessing Readmissions

This evaluation looks at a postdischarge digital engagement (PDDE) program using causal inference methods to examine the impact of PDDE on readmission.

Service Line Care Delivery Model for COVID-19 Patient-Centric Care

The authors provide steps hospitals can take to align their care delivery model to effectively meet the demands of a public health crisis such as the current pandemic.

The Impacts of Supplemental Benefits on Medicare Advantage Plan Composition

After evaluating the association between the expanded Medicare Advantage supplemental benefits and plan composition, authors determined that adoption was not associated with large demographic shifts in enrollment.

The Implementation of Opioid Prescribing Report Cards in Medicaid Managed Care: A Community Quality Collaborative

This article describes the Philadelphia Medicaid Opioid Prescribing Initiative that was launched by a multidisciplinary team and mailed local Medicaid providers individualized prescribing report cards.

Managed Care Reflections: A Q&A With Ge Bai, PhD, CPA

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 October issue features a conversation with Ge Bai, PhD, CPA, professor of accounting at Johns Hopkins Carey Business School and professor of health policy and management at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.

Participating Faculty: The Course and Management of Interstitial Lung Diseases

Contributor: Objective Documentation Protects Patient Access to Home Oxygen Therapy

Facing the challenges created by the COVID-19 pandemic, the US medical community has been forced to rapidly change and modernize the manner in which it delivers health care over the last year-and-a-half. 

Advanced Care at Home at Scale in an Integrated Health Care System

Advanced care at home (otherwise known as hospital at home) can be scaled and provide care for a sizable portion of a hospital’s inpatient census, creating hospital capacity in an integrated delivery system.

A Case-Control Study of Length of Stay Outliers

Length of stay outliers are associated with hospital-acquired infections, complications, and discharge to facility, as opposed to nonmodifiable risk factors like age and comorbidities.

Participating Faculty: Rethinking Heart Failure: Patient Classification and Treatment

Impact of COVID-19 Pandemic on Accessibility of Taiwanese Medical Care

The COVID-19 pandemic disrupted access to routine medical care in community populations in Taiwan. The unmet needs should be emphasized as normal life resumes.

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.

Best Practices Drive Better Payer Negotiations

In today's managed care environment, it is important that contracts between practices and payers include reciprocal language that affords a practice protection over processes, decisions, and changes to the agreement over time, while aligning with its business operation.

Scaling Care Coordination Through Digital Engagement: Stepped-Wedge Trial Assessing Readmissions

This evaluation looks at a postdischarge digital engagement (PDDE) program using causal inference methods to examine the impact of PDDE on readmission.

Identifying Complex Patients Using Adjusted Clinical Groups Risk Stratification Tool

In this study, the authors developed a method for use in primary care to identify a group of patients with complex care needs using Aggregated Diagnosis Groups.

Contemporary Care Patterns in the Management of Small Renal Masses

An investigation of management patterns after initial radiographic diagnosis of small renal masses showed that early urologist referral was associated with guideline-concordant care.

Optimizing Revisit Intervals: Reducing Variability to Enhance Health Care Efficiency

The authors explore the limitations of the current system of revisit interval assignment and discuss the importance of standardization to optimize patient health care outcomes.

Collaborative Care Implementation: Lessons Learned

The authors drafted a “Shared Values of Collaborative Care” document with fundamental principles to make better group decisions in implementing collaborative care.