April 2022

This article presents findings from interviews conducted with executives from 29 Medicare Advantage plans regarding plan decision-making processes related to new social risk factor–related benefits.

This paper examines whether the Affordable Care Act reduced the disparities in the use of clinical preventive services, chronic disease prevalence, and the number of uninsured.

Based on the analysis of electronic health records from 480 clinics, we found that better care quality and continuity are associated with better-than-expected wound healing performance.

2018 was a landmark year for new drug approvals. However, patients’ access to these novel drugs varied by drug category and enrolled health plan.

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.

The authors studied the impact of a pharmacist intervention on blood pressure control compared with usual care.

As promising advances in providing care at home evolve, further research—with special attention to underserved populations—is needed to assess the clinical, equity, and economic impacts and to accelerate implementation where appropriate.

Comparing patients’ experiences with in-home urgent care from community paramedics vs urgent care provided in emergency departments, we found higher satisfaction among patients receiving in-home treatment.

A community-based care management program in Rhode Island reduced hospitalizations and inpatient costs. There were stark differences across subgroups based on intensity of care.

The risk-adjusted 1-year mortality rate was not different between Medicare Advantage and traditional Medicare beneficiaries with kidney failure who initiated dialysis.

Correction to the Original Research article “Behavior-Based Diabetes Management: Impact on Care, Hospitalizations, and Costs” published in the March 2021 issue of The American Journal of Managed Care®.

Despite their intention to protect against coverage denial and/or premium increases, additional state-level Medigap regulations are correlated with lower Medigap enrollment and stronger moral hazard.

Work relative value units (wRVUs) correlate with operative duration of common surgical procedures. Reimbursement for physicians depending on wRVUs is fair for commonly performed surgeries.

Real-world adoption of bevacizumab-bvzr biosimilar was retrospectively assessed, revealing switching between biosimilars and the reference product and utilization in extrapolated indications and combination regimens.