New findings reveal sotatercept's significant benefits for right ventricular function and tricuspid regurgitation in pulmonary arterial hypertension.
Medicaid 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.
The prior authorization process for patients with cancer demonstrates fewer days until submission and lower denial rates for Asian patients relative to White patients.
On 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.
Covered California and Health Net’s novel data exchange initiative significantly improved quality measurement and potentially reduced costs by more than $640,000.
Clinical calculators that do not include demographic variables may be biased, and their equity should be understood in the context of clinical guidelines.
The 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.
Trends 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.
A panel of experts share closing thoughts and advice for the management and uptake of HIV PrEP therapy.
This study presents a methodology for forecasting demand of COVID-19 on health resources in an integrated health system.
The problem of violence against health care workers has escalated across the world, and tackling this issue requires the support of administrators.
This scoping review found 350 articles that discuss US health insurance providers’ use of patient-reported outcomes about health-related quality of life.
Medicare accountable care organizations use preferred skilled nursing facility networks for postacute care management, although the size, structure, and resource allocation of networks vary widely.
Panelists discuss how successful access initiatives include integrated specialty pharmacies, community-based clinics, clinical trial opportunities, telehealth services, and financial assistance programs like 340B to serve underserved populations with atopic dermatitis.
Panelists discuss how SGLT2 inhibitors evolved from diabetes medications to become foundational heart failure therapy with class I recommendations across the ejection fraction spectrum, providing cardiovascular and renal benefits through unclear but likely multiple mechanisms, with the elegant advantage of single-dose efficacy regardless of diabetes status or heart failure type.
The KidneyIntelX test would affect primary care physician (PCP) decision-making, and PCPs would use the results of KidneyIntelX more than albuminuria and estimated glomerular filtration rate when making decisions about diabetic kidney disease management.
Using data from 632 primary care practices, the authors show that the CMS Practice Assessment Tool has adequate predictive validity for participation in alternative payment models.
Considering the personal, societal, and economic toll of treatment-resistant depression, we must make it easier to access medicines and care that provide value, both for the patient and for the health care system.
Physicians have been facing increasing workloads making it difficult to practice medicine as they were trained, but an accountable care organization might provide an opportunity for real change to deliver high-value, compassionate care.
Previous studies have found modest uptake of biosimilars in both commercial and Medicare populations. This study finds that the uptake varies between the rural and urban provider settings.
The authors find that 340B-covered hospitals and grantees are contracting mainly with pharmacies in significantly more affluent neighborhoods than their own.
Patients who revisit the emergency department shortly after discharge are at high risk for complications and death, exacerbated by COVID-19 screening workload. Detection efforts impact outcomes.
“OneOncology was started by physicians and for physicians,” said Jeff Patton, MD, OneOncology CEO. “As we’ve grown and enhanced world-class cancer care in communities across the country, strengthening practice independence and empowering their decision-making has always been our north star."
A decision to rename myeloproliferative neoplasms led to a plethora of developments in a space where there was once little interest.
Medicare expenditures for patients with amyotrophic lateral sclerosis are more than 3 times those of the average Medicare beneficiary, and drug therapies are an important cost driver.
Enrollment in Medicare coverage without out-of-pocket protections was associated with a higher likelihood of reporting cost and access barriers to care.