Top 5 Most-Read AJMC® Journal Articles of 2025

In 2025, the most-read articles published in our flagship peer-reviewed journal, The American Journal of Managed Care^® (AJMC^®), addressed practical challenges and promising fixes across health delivery, payment policy, and technology—topics that matter for clinicians, payers, and health systems alike. Below are the 5 most-read AJMC journal articles of 2025, with short summaries of each article’s findings and implications.

5. Reducing Readmissions in the Safety Net Through AI and Automation

This analysis, set in a safety-net health system, describes a multifaceted initiative that combined predictive artificial intelligence (AI), automated decision support, and standardized care pathways to reduce readmissions and protect pay-for-performance revenue in resource-limited settings. The authors acknowledge limitations in isolating the effect of the predictive algorithm from other system changes, but they conclude that relatively simple automation and decision-support tools—and, where available, predictive models—can help safety-net systems improve outcomes and equity while preserving scarce resources.

Read the full article.

4. Medical Policy Determinations for Pharmacogenetic Tests Among US Health Plans

This landscape analysis reviewed payer and laboratory benefit manager policies for 65 clinically relevant drug-gene pairs and found wide variability in both coverage and the evidence cited to support decisions. The article highlights that some payers (and CMS’ MolDX program) covered many pairs whereas others covered few; consortium guidelines and FDA resources were more likely to drive coverage than cost-effectiveness studies. The authors call for greater transparency and standardized evidence thresholds so that payers, test developers, and clinicians can align on what constitutes clinical utility and improve patient access.

Read the full article.

3. Potential Spillover Effects on Traditional Medicare When Physicians Bear Medicare Advantage Risk

Using a comparison of physician groups with high vs lower Medicare Advantage (MA) risk payment exposure, this research examined outcomes for patients remaining in traditional Medicare (TM). Adjusted analyses showed that TM beneficiaries cared for by physicians with high MA risk exposure had better utilization and quality metrics across most measures, including 9% to 18% lower disease-specific inpatient admissions, 82% higher odds of receiving an annual wellness visit, and lower 30-day readmission rates. The findings suggest that MA risk-based payment arrangements may produce beneficial spillover effects for TM patients, although they did not establish causality.

Read the full article.

2. Cancellations in Primary Care in the Veterans Affairs Health Care System

This large retrospective observational study analyzed all in-person and virtual Veterans Affairs (VA) primary care appointments from October 1, 2018, through April 1, 2024, to quantify same-day cancellations and distinguish those canceled by patients vs for clinic/provider reasons. The article shines a light on clinic-initiated cancellations—an understudied source of access friction in a system that delivers millions of primary care visits annually—and frames cancellations as an important target for operations improvement and patient experience efforts within the VA.

Read the full article.

1. Prior Authorizations and the Adverse Impact on Continuity of Care

Topping our list in 2025, this commentary reviews the mounting evidence that prior authorization (PA) workflows impose substantial administrative burdens, delay or deny needed care, and can disrupt continuity, which may be driving some clinicians toward cash-only practice models. The viewpoint describes provider frustration with opaque, inconsistent PA rules and lengthy processes (including “formulaic” peer-to-peer reviews) and warns that growing dissatisfaction may push both patients and physicians away from traditional insurance arrangements unless reforms are implemented.

Read the full article.