Value-Based Care

The editors in chief of The American Journal of Managed Care® discuss the key managed care research and news from 2024 and look forward to the journal’s upcoming 30th anniversary.

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.

Matias Sanchez, MD, assistant professor in the Department of Medicine, Division of Hematology and Oncology, University of Illinois Chicago, emphasizes the importance of patient education and caregiver involvement in managing complex therapies and advises oncologists to confidently integrate advanced treatments.

Palliative care is quality care, and providers and health systems need to do a better job at ensuring there is equity in palliative care, said 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.

A study finds that telehealth does not lead to an increase in wasteful, low-value care and may even reduce unnecessary tests and procedures.

Carol R. Regueiro, MD, MSc, of Allegheny Health Network, highlights how the Physician Partners of Western PA practice support model has successfully engaged specialty practices to enhance patient connections and promote a population health perspective.

Carol R. Regueiro, MD, MSc, of Allegheny Health Network (AHN), explains how AHN's congestive heart failure bundle has enhanced collaboration between cardiology and primary care.

Health care costs continue to rise despite lower demand, while younger generations increasingly face chronic health challenges.

As the US charts its course through the next political era, it is crucial that we boldly allocate resources and prioritize what truly impacts patients. When faced with complexity, feasibility concerns, or entrenched norms, we must proclaim: “It’s the outcomes, stupid.”

The policy community should consider these concrete suggestions to address the challenges presented by social determinants of health.

As health care moves toward a value-based payment model, the pharmacy benefit is going in the opposite direction, one that places unit cost over clinical appropriateness.

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

Payers and providers face challenges surrounding data integration, patient engagement, and financial pressures when trying to improve care quality and reduce costs.

Viet Le, PA-C, Intermountain Health, gives insights into the benefits cardio-renal-metabolic care models provide for patients in need.

Navdeep Tangri, MD, PhD, FRCP, University of Manitoba, speaks to the value of population health strategies in clinical approaches to care delivery for patients with chronic kidney disease (CKD).