July 2022

This systematic review found that studies of case management interventions have adequate quality and, in many cases, show cost-effective or even cost-saving results.

This article describes the findings of an observational study carried out in India to examine the clinical profile of individuals detected to be COVID-19 positive post vaccination.

The authors propose a novel approach in which physicians’ responsibility for inpatient stays is expressed through physician-specific attribution ratios informed by patient characteristics.

This study developed a novel algorithm for setting automatic auditing thresholds in a Medicaid program in Maryland.

The cost avoidance of heart failure–related hospitalizations and emergency department visits may outweigh the additional drug cost in Medicaid members adherent to sacubitril/valsartan.

This study attempts to identify the sources of the significant 2.5-fold variation found in home health expenditures, a possible indicator of inefficiency and waste.

Four large Medicare Advantage insurers manage access to expensive physician-administered drugs with a combination of prior authorization, step therapy, and Part D formulary design.

A survey was conducted to determine opportunities to aid primary care providers and patients in the difficult journey of an oncology patient.

The objective of this study was to examine the relationship between inpatient opioid receipt and care experiences of women hospitalized for vaginal delivery.

Imposing a surcharge on unvaccinated employees will require employers to think through legal and policy implications.

Projected savings from biosimilars from 2021 to 2025 were $38.4 billion vs conditions as of quarter 4 of 2020 and were driven by new biosimilar entry. Savings were $124.5 billion under an upper-bound scenario.

The different approaches to setting benchmarks for population-based payment models (empirical, bidding based, and administratively set) have unique advantages and challenges.