Authors

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.

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.

Geographic Variability of Medicaid Acceptance Among Allergists in the US

The proportion of allergists accepting Medicaid in the US varied significantly among and within states.

Psoriatic Arthritis Treatment Patterns and Costs Among Pharmacologic Treatment–Naïve Patients

We present results of an analysis of IBM MarketScan databases that evaluates treatment patterns and health care costs for treatment-naïve patients with psoriatic arthritis.

Future Research Can Guide Employer, Policy Strategies to Improve Workforce Well-Being: Refat Rasul Srejon, MPH

Refat Rasul Srejon, MPH, recommends employer coverage for substance use care and follow-up, plus research on local treatment and drug trends.

The Price Paradox of Biosimilar-Like Long-Acting Insulin

Findings suggest that Basaglar was not less expensive for patients than Lantus. Empirical evaluation of biosimilar costs prior to automatic substitution is necessary.

Impact of Co-pay Assistance on Patient, Clinical, and Economic Outcomes

Limited evidence from a literature review suggests that co-pay assistance was associated with improved treatment persistence/adherence across various diseases, with indirect evidence suggesting improvements in clinical outcomes.

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.

The Impact of 1-Star Physician Ratings on New Patient Volume

Analysis of a single-specialty practice’s scheduled appointments and reviews of physicians finds that 1-star ratings have a limited but longitudinal influence on new patient volume.

COVID-19 and MCO-Community Partnerships to Address Enrollee Social Needs

COVID-19 strained already-burdened community partners, affecting service delivery, communication, and partnerships. Managed care organization (MCO) partnerships with these organizations evolved in response to changing needs and resources.

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.

The Association of Social Determinants of Health With Health Outcomes

This study explored the statistical association of key social determinants of health with specific health outcomes to validate impact and then created weighted categorical matrices.

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.

An Accelerated Hospital Observation Pathway to Reduce Length of Stay for Patients With COVID-19

For select patients hospitalized due to COVID-19, an academic urban hospital implemented an observation pathway that incorporated mobile health technology, reducing hospital length of stay by more than 2 days.

Contributor: The Promise of AI in Health Care

Artificial intelligence (AI) could play a pivotal role in health care moving forward.

Clinician Characteristics Associated With Fluoride Varnish Applications During Well-Child Visits

Clinicians treating a higher percentage of patients insured by Medicaid and patients younger than 5 years were more likely to apply fluoride varnish.