Authors

Driving Healthier Outcomes Through Comprehensive, Team-Based Care: Q&A With Marisa Rogers, MD, MPH

In 2025, each issue of Population Health, Equity & Outcomes will feature a profile of a health system leader transforming care in their area of expertise. This issue spotlights a conversation with Marisa Rogers, MD, MPH, chief medical officer at Oak Street Health.

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.

Equity and AI Governance at Academic Medical Centers

This study identifies limited engagement with equity among academic medical centers as they develop governance processes for artificial intelligence (AI)/machine learning and predictive technologies.

Health Equity in the Era of Large Language Models

This article presents challenges and solutions regarding health care–focused large language models (LLMs) and summarizes key recommendations from major regulatory and governance bodies for LLM development, implementation, and maintenance.

AI Seen as Key to Reducing Health Care Claim Denials, Survey Finds

Experian Health’s 2025 State of Claims survey shows rising denial rates, data errors, and low artificial intelligence adoption despite providers’ belief in its potential.

Emergency Department Risk Model: Timely Identification of Patients for Outpatient Care Coordination

The authors created a machine learning–based model to identify patients with major depressive disorder in the primary care setting at high risk of frequent emergency department visits, enabling prioritization for a care coordination program.

Contingency Management: Promises, Gaps, and Philosophical Limitations

This editorial reviews the promises, gaps, and philosophical limitations of contingency management for pregnant people who use drugs.

Reducing Readmissions in the Safety Net Through AI and Automation

Artificial intelligence (AI) and electronic health record–based automation tools helped a safety-net health system meet performance-based readmission metrics, thereby retaining critical funding while improving clinical and equity outcomes.

Revisiting Conclusions on the Empiric Segmentation of High-risk Patients

The authors provide feedback on generalizations made regarding interventions for high-risk populations in previous research.

End-of-Life Values and Value-Based Care

An editorial in response to the editor in chief’s December 2021 letter discusses evidence supporting the cost-effectiveness of an innovative advance care planning initiative.

Using Electronic Health Records and Claims Data to Identify High-risk Patients Likely to Benefit From Palliative Care

Deep learning algorithms could improve palliative care by predicting mortality from electronic health records and claims data.

Effective Prevention and Management of COVID-19 in Outpatient Hemodialysis Patients

The authors introduce a mobile phone app that may effectively prevent and manage coronavirus disease 2019 (COVID-19) in outpatient hemodialysis patients in Sichuan Province, China.

US Spending on High-Revenue Rare Disease Drugs in 2022

One in 5 of the highest-revenue drugs of 2022 was exclusively approved for rare conditions, accounting for more than 7% of US pharmaceutical spending.

Geographical Variation in Kidney Function Testing and Associations With Health Care Costs Among Patients With Chronic Kidney Disease and Type 2 Diabetes

Assessing the Impact of Transplant Case Management on Clinical Outcomes

This article examines the effect of a transplant case management program on clinical outcomes following transplant surgery.

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.

Improving Pulmonary Embolism Outcomes in Intermediate-Risk Patients: Krunal Patel, MD

Krunal Patel, MD, pulmonary and critical care fellow, Temple University Hospital, discusses how early intervention within 12 hours improved hemodynamic measurements and clinical outcomes in patients with pulmonary embolism.

Appropriate ED Utilization Leading to Better Care Coordination

Addressing avoidable emergency department (ED) utilization takes interventions in partnership with providers.

Glucose-Lowering Treatment Patterns in Patients With Diabetic Kidney Disease

Real-world treatment of diabetic kidney disease in the United States, based on national-level health care claims and electronic health records data, is inconsistent with the current guidelines.

Unmet Health Care and Health-Related Social Needs of Laundromat Users

Laundromats offer a promising outreach setting for Medicaid payers because Medicaid enrollees represent a majority of laundromat users and have disproportionately high levels of unmet needs.

Burden of EPS in Commercial Patients With Schizophrenia Initiating Atypical Antipsychotics

This study investigated the 1-year incidence of extrapyramidal symptoms (EPS), as well as the incremental economic burden, in patients with schizophrenia initiating atypical antipsychotics.

Improving Treatment Adherence With LAIs for Comorbid Schizophrenia, Substance Use Disorder

Joshua Kaufman, MD, of CDPHP, discusses the significance of long-acting injectables (LAIs) in improving adherence, reducing the risk of relapse, and preventing hospitalizations.

Transition-to-Dialysis Planning, Health Care Use, and Mortality in End-Stage Renal Disease

A planned transition to dialysis was associated with improved outcomes and lower mortality. These findings may inform care coordination policies for end-stage renal disease.

Insights Into Patient Portal Engagement Leveraging Observational Electronic Health Data

This analysis of more than 250,000 adults at least 50 years old with chronic conditions showed lower portal use among older, non–English-speaking, and Black patients, underscoring digital health equity gaps.

Contributor: A Practical Path Forward to More Patient-Centered Value Assessment

To ensure that value assessment accounts for patient needs, we need a better understanding of the outcomes that are most important to patients, write authors from COVIA Health Solutions and the University of Washington School of Pharmacy.

Do Localized Disasters Impact Clinical Measures of Health Care Quality?

This study examines the impact of geographically limited disasters on health care quality performance scores of Medicare Advantage contracts, finding limited impact on performance scores.

The Impact of Health Benefit Design on Patients With Infertility

This retrospective analysis explored the impact of infertility health benefit design on the use of infertility medications and procedures and pregnancy outcomes.

How English- and Spanish-Preferring Patients With Cancer Decide on Emergency Care

Care delivery innovations to help patients with cancer avoid emergency department visits are underused. The authors interviewed English- and Spanish-preferring patients at 2 diverse health systems to understand why.

Financial Incentives Tied to Medicare Star Ratings: Impact on Influenza Vaccination Uptake in Medicare Beneficiaries

Influenza vaccine uptake improved among Medicare Advantage enrollees when influenza vaccination was introduced as a performance metric in Medicare star ratings and accompanying bonus payments.

Impact of Travel Distance on Quality Outcomes in Colorectal Cancer

This study identified characteristics of patients with colorectal cancer who traveled farther for surgery and found that those who traveled tended to stay longer at the hospital.