Policy

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

This article presents a case study of how stakeholders in one state came together to integrate practice and research that is a step beyond a learning health care system.

Many states are enacting restrictions on insurers’ prior authorization policies, but these laws may increase costs and lead to other undesirable consequences.

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.

The governors of Washington, California, and Oregon have launched the West Coast Health Alliance to provide evidence-based guidance amid shifting CDC policies.

Why is health care so staggeringly difficult to use? How do we fix it? To move forward, we first must look back, because the system we have today was not really designed, it evolved, notes Ariela Simerman, Turquoise Health.

Medicaid expansion significantly improves health coverage and access, yet several Southern states face a persistent coverage gap amid political challenges.

The Trump administration recently signed an executive order to address homelessness, sparking concern in some based on the order's wording.

New research highlights which US counties lead in patient experience, health outcomes, and cost efficiency—and the policies that drive success.

Research reveals a significant decline in reported conflicts of interest among the CDC's and FDA's vaccine advisory committees, challenging Robert F. Kennedy Jr's claims.

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.

Laxmi Patel, chief strategy officer at Savista, outlines major impacts of the “One Big Beautiful Bill” Act on Medicaid and what hospitals can do to prepare for these changes.

Proposed Affordable Care Act (ACA) premium hikes threaten health care access, with potential increases of over 75% for enrollees.

A new partnership delivers a scalable Fast Healthcare Interoperability Resources solution to help payers meet CMS' Interoperability and Prior Authorization Final Rule by 2027.

Robert F. Kennedy Jr halted 22 mRNA vaccine initiatives, drawing criticism from health experts over pandemic preparedness concerns.

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.

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.

Supplemental Nutrition Assistance Program (SNAP) benefits may slow cognitive decline in older adults, highlighting the importance of food assistance in combating Alzheimer disease and dementia risks.

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 August issue features a conversation with Charles N. (Chip) Kahn III, MPH, the president and CEO of the Federation of American Hospitals and a longtime member of the AJMC editorial board.

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

At the 6-month anniversary of the inauguration in January, The American Journal of Managed Care® looks back at the changes made by the Trump administration that could have lasting effects in health care.

Thimerosal, a mercury-based preservative, has been incorrectly linked to the development of autism by antivaccine groups.

The Supreme Court decision in Medina v Planned Parenthood South Atlantic and the subsequent passing of the budget bill leave Planned Parenthood clinics and their patients in a precarious spot, says Danika Severino Wynn, CNM.

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.

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.

These interviews are the top episodes, by listens, from among the 21 podcast episodes The American Journal of Managed Care® produced over the first half of 2025. Give them all another listen, and perhaps learn something new.

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.

ASCO President Robin Zon, MD, FACP, FASCO, emphasizes how AI solutions and advocacy in enhancing cancer care, ensuring equitable access to innovative treatments for all patients.

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.

CMS proposes the 2026 Physician Fee Schedule (PFS), addressing payment disparities in oncology, but the community oncology community warns of financial threats from the Inflation Reduction Act. Updates reflect late Tuesday release of the proposed 2026 schedule for the Hospital Outpatient Prospective Payment System.