Authors

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.

Health Care Resource Utilization, Quality Metrics, and Costs of Bladder Cancer Within the Oncology Care Model

Spending on novel therapies in high-risk bladder cancer had minimal impact on Oncology Care Model payments to practices, according to this cohort study and an average performance estimation.

Hospital Strategies in Commercial Episode-Based Reimbursement

This study reports qualitative findings from an explanatory sequential mixed-methods investigation to understand hospitals’ approaches to a novel commercial episode-based reimbursement incentive program.

Successes and Failures With Bundled Payments in the Commercial Market

The relatively few examples of commercially funded condition-specific bundled payments provide insights into how to spread this alternative payment model further in the private insurance market.

Post-SNF Outcomes and Cost Comparison: Medicare Advantage vs Traditional Medicare

Patients enrolled in Medicare Advantage had better outcomes and lower cost following skilled nursing facility (SNF) discharge than patients enrolled in traditional fee-for-service Medicare.

Current Status and Influencing Factors of Nursing Interruption Events

This study investigated the current status of nursing interruption events and analyzed the time costs, priority of events, and factors influencing interruptions.

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.

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.

Charitable Medication Distribution Improves Care for Uninsured Patients With Diabetes

This report illustrates how providing vital diabetes medications to uninsured patients through a charitable medication distributor improves clinical outcomes.

Social Determinants of Health Score: Does It Help Identify Those at Higher Cardiovascular Risk?

Calculating a social score is feasible and it predicts cardiovascular outcomes. In order to do this, institutions have to collect social determinants of health.

Preoperative Acute Care Spending Predicts Costs in Bundled Payment Programs

Preoperative acute care costs significantly predicted postoperative costs in Bundled Payments for Care Improvement model year 3 surgeries, suggesting that accounting for preoperative factors may improve bundled payment outcomes.

The Unfinished Work of Value-Based Cancer Care

Ohio cancer care leaders identified persistent gaps in quality, pharmacy infrastructure, bispecific access, and biomarker testing at a May 2026 summit.

Intersection of Complexity and High Utilization Among Health Center Patients Aged 18 to 64 Years

This paper utilizes latent class analysis to identify subgroups of complex conditions and of super-utilizers among health center patients to inform clinically tailored efforts.

Timely Preterm-Birth Prediction Among Pregnant Women in Medicaid Without Preterm-Birth History

A novel prediction model is developed that accurately predicts preterm birth in a timely manner among pregnant women in Medicaid without preterm-birth history.

Defining Appropriate Quality Performance Metrics for Pharmacies Dispensing Oral Oncology Therapies

Medicaid Expansion, Managed Care Plan Composition, and Enrollee Experience

Medicaid expansion was associated with substantial changes in Medicaid managed care plan composition, which may influence a plan’s performance on enrollee experience metrics.

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.

Use of Voluntary Alignment in the Next Generation ACO Model

Use of voluntary alignment attribution by Next Generation Accountable Care Organization (ACO) participants was limited. The authors highlight the reasons and describe organizational use cases via a mixed-methods approach.

Differences in Spending for Diabetes and Multiple Chronic Conditions in Michigan Medicare Beneficiaries

Diabetes and multiple chronic conditions increase overall Medicare spending, but spending increases even more in minority beneficiaries compared with White beneficiaries with similar comorbidity combinations.

Rituximab Reference vs Biosimilar Utilization for Oncology vs Nononcology Indications

Reporting on the real-world utilization of reference rituximab and its biosimilars can help show prescribing habits and reveal cost-saving opportunities.

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.

A Patient-Centered Reconstruction of 340B in Oncology: Transparency, Equity, and Site-of-Care Accountability

Community oncology leaders urge 340B overhaul so drug discounts follow vulnerable cancer patients, with audits, transparency, and tighter contract-pharmacy rules. This commentary will be featured on the Cover of the October issue of Evidence-Based Oncology.

Patient-Centered Communication, Disparities, and Patient Portals in the US, 2017-2022

From 2017 to 2022, patients with better communication with providers were more likely to report being offered and accessing a patient portal, but disparities persist.

Pemvidutide for MASH Earns FDA Breakthrough Therapy Designation

FDA granted breakthrough therapy designation to pemvidutide based on its potential in treating metabolic dysfunction–associated steatohepatitis (MASH).

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.

Upper Payment Limit Implementation Risks for Patients, Pharmacies, and Providers

As prescription drug affordability boards move toward upper payment limit implementation, uncertainties introduced across the health care system and risks to patient access warrant urgent attention.

Assessment of Variation in Ambulatory Cardiac Monitoring Among Commercially Insured Patients

Ambulatory cardiac monitors’ clinical and economic outcomes vary; one long-term continuous monitor brand showed greater arrhythmia diagnosis, fewer retests and cardiovascular events, and lower health care resource use and costs.

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.

Leveraging Longitudinal Clinical Laboratory Results to Improve Prenatal Care

Collaboration between a clinical laboratory and a managed care organization improved prenatal care and outcomes through real-time, actionable, laboratory-derived insights and care coordination.

Biosimilar Adoption, Legislative Action With PBMs: JC Scott

JC Scott, CEO and president of The Pharmaceutical Care Management Association, discusses current efforts in increasing biosimilar adoption and pharmacy benefit manager (PBM) reform.