Health Care Cost

In this second part of his interview with The American Journal of Managed Care®, Sanjay Doddamani, MD, MBA, a former senior advisor to CMMI and founder and CEO of Guidehealth, continues a dialogue on the future of value-based care and the promise—and limits—of AI-enabled innovation, reflecting on challenges like rising Medicare costs and patients’ growing financial burdens.

Adults with type 2 diabetes, especially those in vulnerable groups, face higher risks of medical debt, low credit scores, and bankruptcy.

Large language models (LLMs) such as GPT-3.5 and GPT-4 may offer a solution to the costly and inefficient process of manual clinical trial screening, which is often hindered by the inability of structured electronic health record data to capture all necessary criteria.

President Donald Trump has sent letters to pharmaceutical companies, aiming to compel them to lower drug prices in the US to match the lowest prices offered in other developed nations, a move that could significantly reduce costs and disrupt the current system of pharmacy benefit managers.

Given trends in cost and use, insulin out-of-pocket cost reduction policies would be more efficient if they targeted members in high-deductible health plans with savings options and low-income patients.

This study examined the impact of price transparency and prosocial messaging on patient engagement of price-protected consumers in seeking value-based care.

Proceeding with hematopoietic stem cell transplantation (HSCT) is more cost-effective than delaying the procedure in patients with intermediate-risk acute myeloid leukemia (AML).

During a visit to AtlantiCare, CMS Administrator Mehmet Oz, MD, MBA, called for rural health systems to modernize IT infrastructure through the $50 billion Rural Transformation Fund, including through artificial intelligence (AI).

The rapidly increasing prescriptions for expensive specialty medications, rather than their price growth, are the primary driver of escalating dermatology Medicare Part D expenditures, necessitating policies that balance innovation, access, and affordability.

Investigators sought to measure and attribute out-of-pocket costs to cancer stage and by diagnosis.

According to the American Medical Association, blame for the ongoing physician shortage may lie with overly burdensome administrative processes, an antiquated Medicare payment system, and lack of education for residents in primary care and psychiatry.

States participating in the Cell and Gene Therapy (CGT) Access Model will be testing outcomes-based payments for sickle cell disease treatments.

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.

Caroline Vovan, PharmD, CDE, highlights how ambulatory clinical pharmacists contribute to value-based care by managing chronic conditions, improving medication adherence, and reducing costs.

Sanjay Doddamani, MD, MBA, a former senior advisor to the Center for Medicare and Medicaid Innovation, and internist and cardiologist by training, explains how the Wasteful and Inappropriate Service Reduction (WISeR) Model hopes to work, and addresses concerns about delays and denials from revamped prior authorization processes.

Adam Colborn, JD, associate vice president of congressional affairs at AMCP, shares insights on the impact of the Most Favored Nation drug pricing order when it comes to access, affordability, and innovations in US health care.

Medicare inflation rebates fail to curb rising drug prices, highlighting the need for further policy action to control costs.

Europe seizes leadership in global health as US funding cuts create disparities, HHS is sued by multiple medical groups, and new findings highlight gaps in care.

During the Reshaping Rx: Navigating 2025 Drug Pricing Policies webinar, panelists discussed the Most Favored Nation executive order, bills aimed at pharmacy benefit managers (PBMs), and other drug pricing policies.

A webinar held by KFF on July 9 emphasized the immediate effects of the new budget bill, highlighting the impacts on Medicaid and health spending in the next decade.

Families caring for individuals with Duchenne muscular dystrophy (DMD) face significant financial burdens from necessary home and vehicle modifications to enhance quality of life.

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.

Countries in sub-Saharan Africa could see thousands of deaths from HIV due to cuts to the US President’s Emergency Plan for AIDS Relief (PEPFAR), underscoring the necessity of reinstating the program.

Access to and affordability of immune checkpoint inhibitors, which can be lifesaving if patients receive them on time and under optimal circumstances, continue to top the list of reasons behind outcomes disparities for patients who have private insurance vs those who remain uninsured.

The market for artificial sweeteners has been projected to increase by almost 75% from 2025 through 2033, or from $3.11 billion to $5.44 billion.