Policy

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.

Chris Johnson, MBA, emphasizes that the constantly shifting landscape of Medicaid could further confuse both patients and health care providers, potentially leaving children behind.

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.

Treatment challenges that Anasuya Gunturi, MD, PhD, encounters in her work at Lowell General Hospital include language differences and confusion about scheduled appointments.

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.

Clayton Irvine, PharmD, MBA, MS, discusses strategies to address payer-driven biosimilar and prior authorization challenges through integrated digital solutions, while advocating for flexible, regularly reviewed treatment pathways supported by molecular tumor boards and artificial intelligence to balance standardization with personalized, biomarker-driven oncology care.

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.

Some hospitals in New Jersey may be eligible for part of the $50 billion CMS spending on rural health care, according to State Sen Vincent Polistina (R, New Jersey).

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

At the recent regional Institute for Value-Based Medicine® event in Boston, Anasuya Gunturi, MD, PhD, Lowell General Hospital, was a panelist for the discussion, “Evolving Breast Cancer Care: Addressing Unmet Needs Across the Patient Journey.”

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.