Value-Based Care

To mark the 30th anniversary of The American Journal of Managed Care® (AJMC®), each issue in 2025 will include 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 April issue features a conversation with Hoangmai H. Pham, MD, MPH, a member of AJMC’s editorial board and the president and CEO of the Institute for Exceptional Care (IEC).

Strategies to enhance virtual care through quality assurance frameworks, technological innovation, and provider support were laid out in a pair of posters presented at the recent AMGA Annual Conference.

Mapping care management needs by defining patient populations and then stratifying them according to risk and their needs can help to spur the transformation of a siloed health care system into an integrated system that is able to better provide holistic, value-based care despite the many transitions that continue among hospital, primary, specialty, and community care environments.

This commentary explains why comparing a launch price with a value-based price from a cost-effectiveness analysis requires further examination.

Although the gap between low and high value has been established in many areas, insurance design has yet to adapt, according to a panel at the 20th annual Value-Based Insurance Design (VBID) Summit.

This is the fifth and final article in a series on value-based care and the 4 challenges health care organizations must overcome.

On December 10, 2024, cardiologists, researchers, and value-based care experts gathered in Dallas, Texas, to discuss best practices for implementing advances in cardiology care with a value-based mindset, spanning the care continuum from prevention to treatment.

The second Trump administration is expected to bring changes to Medicaid, Medicare Advantage, and the health insurance exchanges, as well as highlight the Make America Healthy Again (MAHA) movement, speakers at the Value-Based Insurance Design Summit said.

Speakers at the 2025 Value-Based Insurance Design summit recapped the accomplishments made over the past 20 years in designing insurance benefits with value in mind and looked ahead to iterations to come.

This is the fourth article in a series on value-based care and the 4 challenges health care organizations must overcome.

Time costs, often overlooked in health care, create economic burdens for patients and caregivers, impacting income and well-being.

Medicare beneficiaries treated by physicians with high levels of Medicare Advantage risk exposure had higher care quality and efficiency outcomes compared with those treated by other physicians.

Higher telemedicine adoption among Medicare beneficiaries was associated with a slight increase in total visits but a reduction in certain low-value tests and related spending.

Travis Brewer, vice president of payer and public health strategy/relations at Texas Oncology, shared that value-based oncology care can achieve both cost efficiency and high-quality outcomes through integrated multidisciplinary teams, flexible payment models, and targeted treatment approaches.

Discussions also delved into the complexities of value-based oncology care, the growing role of real-world data, and strategies to improve access to care in hematology. Across all sessions, a common theme emerged: the need to balance innovation with patient-centered, equitable, and sustainable care models.

The authors advocate for the implementation of value-based principles to address the underutilization and limited supply of home care and rehabilitation services.

High-intensity home-based rehabilitation (HIHR) may substitute for facility-based postacute rehabilitation. Patients in HIHR had better functional outcomes at lower costs than patients in facility-based care.

An Institute for Value-Based Medicine regional event in Houston, Texas, covered inconsistencies with the integration of precision medicine in oncology practices, the evolution of treatment for multiple myeloma, and more.

Song Park, MD, University of Washington Medicine, advocates for more user-friendly technology to support equitable skin cancer care access.

The American Journal of Managed Care®’s Strategic Alliance Partnerships provide valuable insights into health care trends through collaborations with health systems, payers, oncology practices, and more.

In 2024, the most-read articles published in Population Health, Equity & Outcomes (PHEO) highlighted the promise of accountable care, coverage challenges for obesity therapies, and much more.

In 2024, the most-read articles published in our flagship peer-reviewed journal, The American Journal of Managed Care® (AJMC®), touched on disease burden, policy consequences, and more.

Since its founding in 2012, the National Association of ACOs has evolved from a group of 30 to 477 accountable care organization members covering 9.2 million beneficiary lives.

Preventing or delaying the onset of end-stage kidney disease is vital. By implementing a results-driven, value-based approach, Dallas Nephrology Associates has demonstrated improved patient outcomes and value for payers.

The authors discuss multiple challenges to the production of policy-relevant results from evaluation of Medicare accountable care organizations (ACOs).

Among commercial and Medicare supplemental beneficiaries with cost sharing, higher out-of-pocket spending for the first cardiac rehabilitation session was associated with lower program adherence.

The 6-year mandatory Increasing Organ Transplant Access Model aims to boost kidney transplants and address disparities by incentivizing hospitals, enhancing care coordination, and measuring transplant outcome performance.

The US can learn from what other countries are doing well to implement the best programs to improve patient access to care, especially for those who have the worst outcomes, explained Nadine J. Barrett, PhD, MA, MS, FACCC, of Wake Forest University and the Association of Cancer Care Centers.

At CAQH Connect 2024, health care leaders discussed advancing value-based care through collaboration, data standardization, patient-centered approaches, and adaptable partnerships.