This article examines the prevalence of pay-for-performance incentives to promote human papillomavirus vaccination and other quality metrics as reported by frontline clinical staff.
July 2025
Patients who experienced a formulary-related rejection of cariprazine for adjunctive treatment of major depressive disorder had significantly higher hospitalization rates than those with approved claims.
Assertive community treatment, a strongly evidence-based practice for delivering care to individuals with schizophrenia and low health care engagement, is applicable to disengaged, medically complex patients.
High-Risk Care Management Impact on Medicaid ACO Utilization and Spending
ByKathryn Corelli, MD,Erin Duralde, MD,Diya Mathur, BA,Mary Price, MA,Nicole M. Benson, MD, MBI,Nishmi Abeyweera, AB,Vicki Fung, PhD,Christine Vogeli, PhD,Katherine H. Schiavoni, MD, MPP,Maryann M. Vienneau, BS,Mallika L. Mendu, MD, MBA,Lindsay Jubelt, MD, MS,Gregg S. Meyer, MD, MSc,John Hsu, MD, MBA, MSCE
In Massachusetts’ largest Medicaid accountable care organization (ACO), high-risk care management significantly reduced spending, emergency department visits, and hospitalizations, demonstrating that targeted strategies can manage health care costs amid budget constraints.
Accountable care organization (ACO) participation was associated with an increase in hospitals’ mean market share and with additional market share gains in more concentrated markets.
Although use of corticosteroid premedication prior to infliximab infusions is declining, it remains unnecessarily high despite limited benefit and the risk of serious adverse events from corticosteroids.
To mark the 30th anniversary of The American Journal of Managed Care (AJMC), each issue in 2025 includes a special feature: reflections from a thought leader on what has changed—and what has not—over the past 3 decades and what’s next for managed care. The July issue features a conversation with David J. Shulkin, MD, a physician and former secretary of the US Department of Veterans Affairs.
This study validates criteria to identify patients with inflammatory bowel disease (IBD) at risk of worsening disease who may benefit from early treatment with advanced therapies.
This commentary explains why comparing a launch price with a value-based price from a cost-effectiveness analysis requires further examination.
This systematic literature review and pooled rates analysis investigated the standard of care for patients with heart failure in the US post hospital discharge.
The high cost of incretin mimetics for weight management limits insurance coverage and potentiates variation in utilization management strategies to control near-term spending.
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