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Private Label BiosimilarsThe expert panel discusses the greater potential for private label biosimilars.
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Risk Adjusting for Medicaid Participation in Medicare AdvantageWhen comparing risk-adjustment approaches based on Medicaid status of Medicare beneficiaries, this analysis found that predicted spending levels varied depending on states’ Medicaid eligibility criteria.
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Clinical Setting of Initial Psychotic Spectrum Disorder Diagnoses in an Integrated Health SystemThis study examines the clinical settings of first-time psychotic spectrum disorder diagnoses in an integrated health system.
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Long-Term Health Care Costs Following COVID-19: Implications for Pandemic PreparednessA difference-in-differences analysis of health care claims data evaluated excess health care costs in the 12 months following COVID-19 diagnosis among the general and older adult populations.
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Variation in Spending Associated With Primary Care PracticesPhysician practices account for a significant amount of variation in spending.
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Leveraging Longitudinal Clinical Laboratory Results to Improve Prenatal CareCollaboration between a clinical laboratory and a managed care organization improved prenatal care and outcomes through real-time, actionable, laboratory-derived insights and care coordination.
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Potential Impact of Emerging Therapies on Patients Living with ITPAn expert discusses the rapidly evolving landscape of ITP treatments, highlighting emerging therapies such as Bruton’s tyrosine kinase inhibitors, neonatal Fc receptor antagonists, anti-CD38 antibodies, and innovative approaches like CAR T-cell therapy that offer new hope for improved patient outcomes.
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Long-Term Health Care Costs Following COVID-19: Implications for Pandemic PreparednessA difference-in-differences analysis of health care claims data evaluated excess health care costs in the 12 months following COVID-19 diagnosis among the general and older adult populations.
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Contributor: The Case for Education and Clinical Decision Support With PharmacogeneticsPrescribing is a complex process with multiple factors to consider on top of the 3 primary questions about effectiveness, harm, and cost. Pharmacogenetics has put this complexity under the spotlight and prompted educational programs and the development of new clinical decision support systems.
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Long-Term Health Care Costs Following COVID-19: Implications for Pandemic PreparednessA difference-in-differences analysis of health care claims data evaluated excess health care costs in the 12 months following COVID-19 diagnosis among the general and older adult populations.
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Trends in Medicare Part D Coverage of Generics With Equivalent Brand-Name DrugsHigh-tier generic drug placement in Medicare Part D has increased over time, but it may be related to a drug’s clinical profile and availability of substitutes rather than preferred brand-name drug coverage.
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Building Community and Advancing Care at MDA 2025One of the major highlights of the Muscular Dystrophy Association (MDA) Clinical & Scientific Conference is that invaluable networking opportunities can help clinicians elevate their own best practices.
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Cost Analysis of Self-Monitoring Blood Glucose in Nonintensively Managed Type 2 DiabetesAnalysis of claims data showed reduced utilization and costs among patients with nonintensively managed type 2 diabetes using self-monitoring of blood glucose compared with continuous glucose monitoring.
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Climate Change Impacts Allergy Health Risks: Gary Falcetano, PA-C, AE-CGary Falcetano, PA-C, AE-C, discussed the correlation between climate change and allergy health risks.
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The Effect of Medicare Eligibility on Diagnosis of Chronic ConditionsMedicare coverage did not necessarily lead to increased diagnosis of chronic conditions.
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Sotatercept Shows Right Heart Gains in PAH: Anjali Vaidya, MDNew findings reveal sotatercept's significant benefits for right ventricular function and tricuspid regurgitation in pulmonary arterial hypertension.
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Addressing STIs Through Managed Care: Opportunities in Medicaid and BeyondMedicaid and other managed care organizations could take several key steps to respond to the sexually transmitted infection (STI) epidemic in the US, including congenital syphilis.
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Racial and Ethnic Disparities in Prior Authorizations for Patients With CancerThe prior authorization process for patients with cancer demonstrates fewer days until submission and lower denial rates for Asian patients relative to White patients.
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New Research Challenges Assumptions About Hospital-Physician Integration, Medicare Patient MixOn this episode of Managed Care Cast, Brady Post, PhD, lead author of a study published in the April 2025 issue of The American Journal of Managed Care®, challenges the claim that hospital-employed physicians serve a more complex patient mix.
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Using Data Exchange to Improve Quality Reporting, Target Outreach, and Reduce CostCovered California and Health Net’s novel data exchange initiative significantly improved quality measurement and potentially reduced costs by more than $640,000.
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Investigating Real-world Consequences of Biases in Commonly Used Clinical CalculatorsClinical calculators that do not include demographic variables may be biased, and their equity should be understood in the context of clinical guidelines.
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Child and Adolescent Obesity Exacerbated During the COVID-19 PandemicThe aim of the study was to not only observe the disparities exacerbated by the COVID-19 pandemic but also to draw attention to the issue to drive real, lasting change.
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Assessing Surveillance Utilization and Value in Commercially Insured Patients With Colorectal CancerTrends in surveillance testing after treatment for colorectal cancer remained relatively stable recently, and patients who overutilized surveillance measures had quicker recurrence detection but higher costs.
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Key Takeaways for the Management of HIV PrEPA panel of experts share closing thoughts and advice for the management and uptake of HIV PrEP therapy.
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Continuously Updated Forecasting of SARS-CoV-2 in a Regional Health SystemThis study presents a methodology for forecasting demand of COVID-19 on health resources in an integrated health system.
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The Persistent Pandemic of Violence Against Health Care WorkersThe problem of violence against health care workers has escalated across the world, and tackling this issue requires the support of administrators.
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A Scoping Review of US Insurers’ Use of Patient-Reported OutcomesThis scoping review found 350 articles that discuss US health insurance providers’ use of patient-reported outcomes about health-related quality of life.
