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A Strategy to Promote Population-Wide Life Satisfaction While Advancing Equity

The authors used health care claims and survey data to identify a strategy that might promote life satisfaction while advancing equity in an insured population.

Taking Action to Address Health Equity in Oncology

Empiric Segmentation of High-risk Patients: A Structured Literature Review

Data-driven segmentation of high-risk patient populations may inform health system interventions, but results are dependent on the data sources and methods applied.

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.

Participating Faculty: Perspectives in Bronchiectasis Management

Mental Health Service Utilization Review Patterns in a Medicaid Managed Care Program

Medicaid managed care utilization review data for mental health services were analyzed for the calendar years 2017 and 2018. These data indicate low rates of utilization review denials for both inpatient and outpatient mental health services.

Navigation and Clinician Payment Investments Enhance Colorectal Cancer Screening Benefits

Investing in patient navigation and clinician incentives ensures colorectal cancer screening completion, improves early detection, reduces disparities, achieves cost savings, and advances population health for all stakeholders.

Evolving Knowledge of the Unmet Needs in Dry Eye Disease

Insurance-Related Differences in Chronic Conditions Data Warehouse Comorbidities of Medicare Beneficiaries

Chronic Conditions Data Warehouse comorbidity data vary by insurance status. Analyses using these data that fail to account for insurance status are subject to information bias.

The PANDEMIC Framework for Encouraging COVID-19 Vaccinations

This commentary offers 8 promising approaches forming a framework known as PANDEMIC to address COVID-19 vaccination hesitancy.

Health Care Costs Associated With Unrecognized Progression to Late-Stage Kidney Disease

Unrecognized disease progression is associated with higher health care costs both for patients with end-stage kidney disease and late-stage (stages G4-G5) chronic kidney disease.

Defining a Path Toward Improved Heart Failure Care

Impact of Medicaid Institution for Mental Diseases Exclusion on Serious Mental Illness Outcomes

Medicaid’s Institution for Mental Diseases (IMD) rule bars federal funding for psychiatric facilities with more than 16 beds, but findings indicate that state waivers allowing treatment of serious mental illness in IMDs do not increase overall psychiatric hospitalizations.

CMS Practice Assessment Tool Validity for Alternative Payment Models

Using data from 632 primary care practices, the authors show that the CMS Practice Assessment Tool has adequate predictive validity for participation in alternative payment models.

Economic Burden of Nonadherence to Standards of Diabetes Care

Using propensity score matching in a US nationally representative sample, authors found the effect of nonadherence to diabetes guidelines on health care expenditures of patients with diabetes.

Impact of Including Drug Spending in Oncology Alternative Payment Models

This study demonstrates a method for understanding the effects of drug spending in the design of alternative payment models.

Primary Care Referrals to Nephrology in Patients With Advanced Kidney Disease

Primary care physicians did not refer the majority of patients with severe nephropathy to specialists; nonreferred patients had fewer comorbidities and might be better kidney transplant candidates.

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.

Contributor: Navigating Health Equity in 2024: The Evolution of Accountability, Part 2

The article emphasizes the significance of accreditations in addressing health disparities and promoting health equity, highlighting programs for achieving accreditation and advocating for the integration of social determinants of health (SDOH) and health equity practices within pharmacy and health care.

ACA Medicaid Expansion Association With Racial Disparity Reductions in Timely Cancer Treatment

Medicaid expansion was associated with a reduction in the racial disparity in timely treatment of patients with advanced cancer in the United States.

Why Thyme Care Succeeds Where Value-Based Care Has Fallen Short

Thyme Care bets on ePRO-driven toxicity monitoring to cut Medicare oncology adverse events, infections and ED visits—making value-based care finally work.

Socioeconomic and Racial Disparities in Guillain-Barré Syndrome

Socioeconomic, racial, and institutional factors significantly affect treatment access and patient outcomes in Guillain-Barré syndrome, despite standardized care guidelines in the US.

Long-term Medication Adherence and Preventive vs Reactive Care Utilization Among Older Adults With Diabetes

This study using Medical Expenditure Panel Survey data found greater health care utilization and expenditure among adults 65 years and older who were adherent to oral hypoglycemic agents.

ATS 2026 Highlighted Collaboration and Innovation in Pulmonary Medicine

ATS 2026 showcased new pulmonary therapies, clinical trials, and cross-specialty collaboration to improve patient care.

Impact of Primary Care Intensive Management on Medication Adherence and Adjustments

The Veterans Health Administration implemented primary care intensive management for high-risk patients. Impacts of this program on patients’ medication adherence and adjustments were modest.

Applying Upstream Problem-Solving to Value-Based Payment Reform in Specialty Care: Blue Cross Blue Shield of North Carolina’s Approach

Effectively designing and implementing value-based payment reform for specialty care is challenging. The authors describe a commercial payer’s strategic approach to specialty value transformation.

Legal Issues in Value-Based Care Contracts for Self-Insured Employers

Self-insured employers face regulatory challenges when adopting value-based contracts, requiring careful data governance, standardized metrics, and legal frameworks to align with federal value-based care models.

Mental Health Diagnoses and Services Utilization Vary by Wage Level

Insured lower-wage employees had lower prevalence of mental health conditions but greater severity, with more hospital admissions and emergency department visits than high-wage employees.

The Extent and Growth of Prior Authorization in Medicare Advantage

Prior authorization is a common utilization-management tool among Medicare Advantage plans. However, service-, area-, and carrier-level patterns suggest variation in how plans use prior authorization.

A Scoping Review of US Insurers’ Use of Patient-Reported Outcomes

This scoping review found 350 articles that discuss US health insurance providers’ use of patient-reported outcomes about health-related quality of life.