A. Mark Fendrick, MD

Innovative, cost-neutral plan designs that cover more essential services on a predeductible basis, while decreasing exposure to and spending on harmful care, would better meet the clinical and financial needs of millions of Americans.

This study evaluates the ease of ordering high- and low-value clinical services in a national sample of electronic health records.

The competing strategies of patient assistance programs and co-pay accumulator adjustment programs create confusion and administrative burden for clinicians and patients, potentially reducing adherence to clinically indicated services and worsening patient outcomes.

For primary care to fulfill its promise of promoting a healthier population and more efficient spending, deliberate efforts to curtail the use of low-value services are warranted.

When it comes to the political iceberg of drug prices, there is more than meets the eye. Policies that reduce prices but do not lower consumers’ out-of-pocket costs will not address the main challenge facing most Americans.

New value frameworks should incorporate real-world evidence that reflects patient treatment behavior, adherence to medication, and equity concerns arising from disparities in care.

Health system leaders, policy makers, payers, and consumer advocates should use multiple synergistic levers to reduce the use of care that does not provide clinical benefit.

The implementation of alternative payment models that successfully capture clinical heterogeneity—without adding unacceptable levels of administrative complexity—may be equally (if not more) important than site-neutral payment policies.

More consideration should be focused on consumer decision making and the quality and costs of acute care, and less attention should be paid to where care is delivered.

Higher cost sharing is associated with reduced branded antidepressant initiation among patients trying generic therapy. Dynamic benefit designs could enhance access to branded medications when appropriate.

Amending regulations to expand the “safe harbor” by allowing predeductible coverage of high-value services and medications for chronic diseases would provide Americans a plan option that better meets their clinical and financial needs.

Retail prices for commonly prescribed drugs are often absent from state prescription drug price websites, but when reported, can vary substantially.

Following the results of the recent presidential election, AJMC® Co-Editors-in-Chief weigh in on the implications of this new chapter in health reform.

Arkansas has implemented multi-payer payment reform incorporating both episodic and Patient-Centered Medical Home models. Early perceptions of a sample of stakeholders were largely positive to date.

It is with an incredibly heavy heart that we must announce the death of our good friend and AJMC associate editor, Seema Sonnad. Seema suffered a fatal cardiac arrhythmia while running an ultramarathon in Seattle.

The founding mission of AJMC was to bring the best available and most relevant evidence regarding efficient clinical and managerial practice to a broad spectrum of healthcare stakeholders-a mission that remains unchanged to this day.

The authors provide a framework to capture additional benefits that may result from VBID programs, extending beyond utilization and outcomes to productivity, engagement, and talent.

The United States is in the throes of multiple experiments aimed to shift care delivery from a volume-based to a value-based system. This issue of AJAC examines a number of cutting-edge strategies.

The authors comment on the growth of drug plans with tiers for "non-preferred" generics, and argue that most are inconsistent with established principles of formulary design.

The authors found no consistent pattern in the concordance between CER evidence and subsequent utilization patterns.

In conjunction with provider-oriented payment reform, tools like VBID that change the focus from how much to how well we spend our healthcare dollars.

This commentary discusses why antibiotics and the treatment of infectious diseases present a special case for pharmaceutical development, pricing, and appropriate utilization.

Cliff Goodman, PhD, moderated a panel discussion on the Implications of Healthcare Reform: 'No' Will Be Heard.

Implications of Healthcare Reform: 'No' Will Be Heard is led by Cliff Goodman, PhD, in a panel discussion featuring A. Mark Fendrick, MD, co-editor in chief of The American Journal of Managed Care, John L. Fox, MD, MHA, and Ira M. Klein, MD, MBA, FACP. The panelists determine what it means when a patient says no.