AJMC® in the Press, October 16, 2026

The study “Cost Differential by Site of Service for Cancer Patients Receiving Chemotherapy,” published in The American Journal of Managed Care® (AJMC®) in March 2015, analyzed 2008 to 2010 commercial claims for 70,984 patients receiving chemotherapy. Patients treated in community oncology clinics had a 30% lower mean per-member-per-month cost than those treated in hospital outpatient settings ($6,578 vs $9,412), with the gap ranging from 20% to 39% by cancer type. The difference was held across ages, number of chemotherapy sessions, and urban, suburban, and rural locations.

The Health and Global Policy Institute (HGPI), a Tokyo-based think tank, cited the study in an October 2026 policy column arguing that Japan should move routine and long-term blood cancer care closer to patients’ homes, noting that hospital-based hematologists outnumber community-based ones about 40 to 1. The column presents US community oncology as one of three international models, alongside England’s Cancer Alliances and Ireland’s hub-and-spoke system, and uses the AJMC study to support its point that community-based treatment generally costs less than hospital care. HGPI urged Japan to expand community hematology and remove reimbursement disincentives that discourage hospitals from sending physicians to community institutions.

The commentary “Navigating the Evolving Landscape of Private Cardiology Practice,” published in AJMC in March 2026, examined US cardiology’s shift from physician-owned practices toward hospital integration and private equity ownership. It reported that hospital employment of cardiologists rose from about 26% in 2008 to nearly 63% in 2019 and that only 10% to 12% of practices remained independent by 2022. The authors argued that consolidation tends to raise costs without consistently improving outcomes. They recommended strategies such as clinically integrated networks, comanagement agreements, and hybrid models to preserve independence.

Becker’s ASC Review cited the commentary’s employment and independence figures to open its story on physician-led companies betting that hospital employment has peaked. The article profiled the October 2026 combination of CardioOne and CardioSphere, which help employed cardiologists set up independent practices and then partner with health systems through co-management, professional services agreements, and joint-venture ASCs. This approach mirrors the strategies the AJMC authors recommended.

The commentary “Contributor: Prior Authorization in 2026—CMS Is Rebuilding the Operating Model,” published on AJMC.com in April 2026, examined CMS’s proposed rule bringing drugs under both medical and pharmacy benefits into electronic prior authorization. The proposal sets decision deadlines of 24 to 72 hours and requires more specific denial reasons and public reporting, with compliance beginning in 2027. Citing KFF, it reported that Medicare Advantage insurers denied 4.1 million of 52.8 million prior authorization requests in 2024 (7.7%). Only 11.5% of denials were appealed, but 80.7% of appeals were at least partially overturned.

Tech Times’ “Health care Consultant Jocelyn Freimuth Tracks the Rebuild of Prior Authorization” names AJMC directly twice: for the Medicare Advantage denial figures in its opening line and for the point that authorization delays can lead to extra office visits, hospitalizations, and higher out-of-pocket costs. It also draws on the commentary’s appeal statistics and rule details without attribution. The article then turns to health care consultant Jocelyn Freimuth, who argues that the rule’s success should be measured by shorter patient waits. She advises pharmacies and clinics to take ownership of pending authorizations and appeal routinely.