Policy

These findings support the claim that Medicare Advantage (MA) payments may be driven more by diagnosis and coding practices rather than differences in disease burden between MA and fee-for-service (FFS) Medicare beneficiaries.

Health care institutions with large numbers of Medicare and Medicaid patients may be constrained from offering cancer therapies made available under the accelerated approval pathway.

The rising frequency of natural disasters due to climate change could make health plans more susceptible to significant negative effects, according to Maria DeYoreo, PhD, of RAND Corporation.

The Trump administration argues that HHS Secretary Robert F. Kennedy Jr can overrule the US Preventive Services Task Force to determine the preventive services covered under the Affordable Care Act.

The study found no evidence that geographically limited disasters significantly reduced annual quality performance scores, highlighting the resilience of these programs.

President Donald J. Trump pushed for significant health care changes during his first month back in office, through executive orders affecting managed care, drug pricing, and clinical trial diversity guidance.

The House budget includes cutting $880 billion from programs under the House Energy and Commerce Committee's jurisdiction, which include Medicaid.

Comparing plans with similar characteristics, such as size, geographic location, or demographics served, allows for more meaningful insights and improvement opportunities.

While Republican state-led efforts aim to increase restrictions to abortion care and access to mifepristone and misoprostol in 2025, JAMA authors join the conversation with their published research and commentary.

The upcoming Supreme Court hearing on Braidwood Management v Becerra could affect how preventive services are covered by both public and private insurance.

As enrollment shifts to the Affordable Care Act (ACA) marketplace following the unwinding of Medicaid and the Trump administration begins to implement health policy changes, Molly Dean, MSW, Siftwell's policy advisor, shares insight on how to adapt.

The executive order calls for recommendations on how to expand access and reduce costs for in vitro fertilization (IVF) treatment.

The study aimed to assess the effect of localized disasters on health plan quality performance scores, according to lead investigator Maria DeYoreo, PhD, of RAND Corporation.

For this retrospective study, the authors examined data on more than 3 million screening mammographies for more than 1 million female patients; of the screenings, 23.6% had abnormal results and only 6.7% were recommended for biopsy.

On this episode of Managed Care Cast, we speak with the author of a study published in the February 2025 issue of The American Journal of Managed Care® to uncover significant differences in coverage decisions for pharmacogenetic tests across major US health insurers.

Regina Barragan-Carrillo, MD, a postdoctoral fellow at City of Hope Comprehensive Cancer Center, discussed findings that show 76% of renal cell carcinoma trials take place in wealthy countries, amid news that clinical trial access for the world's poor may become even more challenging.

The Senate voted 52-48 to confirm Robert F. Kennedy Jr as secretary of HHS, setting up the vaccine skeptic to carry out major changes in pursuit of his Make America Healthy Again agenda.

In an interview, Debra Patt, MD, PhD, MBA, FASCO, discusses the priorities of the Community Oncology Alliance as she starts her term as president.

George Jones of UpScript Health discusses telemedicine's evolution from basic e-prescribing to real-time video consultations, expanding treatment beyond primary care.

This analysis demonstrated significant variability in medical policy determinations and evidence cited for clinically relevant pharmacogenetic tests among major US health insurers and laboratory benefit managers.

During the unwinding of continuous Medicaid provisions, 8.7% of pediatric patients at community-based health organizations became uninsured, with higher rates among older children, females, and those with chronic medical conditions.

Access and affordability are among the top priorities in health care for Americans who participated in the survey.

Abandoning efforts to reform payment for cell and gene therapies for Medicaid beneficiaries could allow ongoing access barriers to persist, said Adam Colborn, JD, of AMCP.