Payers

The study confirms that biologics are highly effective in real-world HS management, and highlights the need for a comprehensive treatment strategy considering both skin symptoms and systemic health.

Oncology utilization management often frustrates patients and payers, but collaboration and artificial intelligence can streamline processes and improve care quality, according to Vishnukamal Golla, MD, MPH.

John Byrnes of Banner|Aetna emphasizes collaboration and data-driven strategies to enhance care quality, access, and affordability in health care.

This case study describes Tennessee’s process for convening key stakeholders to develop uniform payment guidelines to encourage increased preventive service delivery.

To mark the 30th anniversary of The American Journal of Managed Care, 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 September issue features a conversation with Dora Hughes, MD, MPH, chief medical officer and director of the Center for Clinical Standards and Quality at CMS.

A new joint guideline from the American Heart Association and the American College of Cardiology emphasizes early treatment, close perinatal blood pressure monitoring, and incorporating the PREVENT risk calculator to personalize care.

Joanne Mortimer, MD, FACP, FASCO, discusses the practical applications and limitations of circulating tumor DNA (ctDNA) testing in breast cancer, highlighting its role in guiding targeted therapy, challenges in patient communication and payer coverage, and unique barriers for male patients.

Patients with severe sickle cell disease experienced significant quality of life improvements after receiving exagamglogene autotemcel gene therapy.

Targeted “Food is Medicine” interventions can help individuals with diet-sensitive chronic conditions improve their health, but nationally representative survey and qualitative interviews showed low awareness despite high interest among respondents.

Matias Sanchez, MD, a hematologist-oncologist at University of Illinois Health, discussed strategies to deliver cutting-edge multiple myeloma care while mitigating costs.

Given the track record of good outcomes and savings, policy leaders must do more to promote growth of for-profit PACE programs, the author asserts.

The FDA approved zopapogene imadenovec, the first therapy for recurrent respiratory papillomatosis, providing an option beyond repeated surgeries to manage the rare condition.

Children with spinal muscular atrophy (SMA) showed motor function improvements after switching to onasemnogene abeparvovec following prior treatment with nusinersen or risdiplam in a real-world study.

DYNE-251 received FDA breakthrough therapy designation, showcasing its potential for patients with Duchenne muscular dystrophy (DMD).

This retrospective analysis explored the impact of infertility health benefit design on the use of infertility medications and procedures and pregnancy outcomes.

Taletrectinib was added to the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology as a preferred option for the first-line and subsequent treatment of advanced ROS1-positive non–small cell lung cancer (NSCLC).

A new survey reveals widespread consumer frustration with prior authorization, highlighting the need for urgent reform in insurance coverage.

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.

Brentuximab vedotin combined with cyclophosphamide, doxorubicin, and prednisone (CHP) shows promising results as a first-line treatment in newly diagnosed peripheral T-cell lymphoma (PTCL).

There is a great need to streamline the process from the tissue sample to the diagnostic lab, whether it's genomic or immunohistochemistry, Robert Kratzke, MD, says.

Revumenib is now the sole targeted therapy recommended by the National Comprehensive Cancer Network for KMT2A-rearranged acute leukemia, which opens a path for payers, said Ivo Abraham, PhD, RN, of The University of Arizona.

Sadie Dobrozsi, MD, of Evolent, discusses how predictive genomics is pushing cancer care into a new era of personalization

Jayme Ambrose, DNP, RN, CCM, of Adobe Population Health, explores how addressing social determinants of health transforms maternal care delivery, reduces disparities, and improves outcomes for mothers and infants.

Artificial intelligence (AI) transforms oncology by enhancing clinical decision-making, improving patient outcomes, and shaping future health care training, as discussed by experts at Tennessee Oncology's “Tech Innovations in Community Oncology."

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