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Latest:
Impact of Food Affordability on Diabetes-Related Preventable HospitalizationMedicaid enrollees residing in counties with greater food affordability had lower odds of preventable hospitalization related to diabetes.
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Prior Authorization Requirements for Calcitonin Gene-Related Peptide AntagonistsThis quantitative and qualitative analysis highlights differences in prior authorization requirements for migraine drugs from nearly 50 managed care organizations and summarizes broad types of criteria used.
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Care Quality Metrics in Medicare During COVID-19 PandemicMedicare Advantage outperformed traditional Medicare on clinical quality measures before and during the COVID-19 pandemic; mid-pandemic, however, traditional Medicare narrowed the gap on some in-person screenings.
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Primary Care Visit Cadence and Hospital Admissions in High-Risk PatientsPatients with congestive heart failure and/or chronic obstructive pulmonary disease who had more quarterly primary care visits had lower rates of hospitalizations during the COVID-19 pandemic.
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Managed Care Cast Presents: Leveraging Topical Therapies for Pediatric Atopic DermatitisExperts discuss how topical therapies effectively manage atopic dermatitis in pediatric patients, enhancing outcomes and addressing unique challenges.
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Scaling Care Coordination Through Digital Engagement: Stepped-Wedge Trial Assessing ReadmissionsThis evaluation looks at a postdischarge digital engagement (PDDE) program using causal inference methods to examine the impact of PDDE on readmission.
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Service Line Care Delivery Model for COVID-19 Patient-Centric CareThe authors provide steps hospitals can take to align their care delivery model to effectively meet the demands of a public health crisis such as the current pandemic.
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Leveraging Patient Activation to Improve Kidney Health in High-Risk PatientsFrequency of patient-provider conversations and patient activation are the 2 most significant predictors of a high-risk patient’s behaviors to prevent kidney disease.
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The Impacts of Supplemental Benefits on Medicare Advantage Plan CompositionAfter evaluating the association between the expanded Medicare Advantage supplemental benefits and plan composition, authors determined that adoption was not associated with large demographic shifts in enrollment.
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The Implementation of Opioid Prescribing Report Cards in Medicaid Managed Care: A Community Quality CollaborativeThis article describes the Philadelphia Medicaid Opioid Prescribing Initiative that was launched by a multidisciplinary team and mailed local Medicaid providers individualized prescribing report cards.
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Managed Care Reflections: A Q&A With Ge Bai, PhD, CPATo mark the 30th anniversary of The American Journal of Managed Care, each issue in 2025 includes a special feature: reflections from a thought leader on what has changed—and what has not—over the past 3 decades and what’s next for managed care. The October issue features a conversation with Ge Bai, PhD, CPA, professor of accounting at Johns Hopkins Carey Business School and professor of health policy and management at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland.
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CNS Penetration and Efficacy of Emerging TherapiesPanelists discuss how CNS-active EGFR TKIs are improving intracranial outcomes and influencing treatment selection in NSCLC.
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Practical Considerations for ITP Therapy Selection and Future ResearchAn expert discusses how rilzabrutinib uniquely improves quality-of-life metrics, including fatigue and women’s health domains, which previous immune thrombocytopenia (ITP) therapies failed to address despite raising platelet counts. An expert discusses how rilzabrutinib’s oral administration and broad tolerability make it a practical treatment option while emphasizing the need for long-term efficacy and safety data to strengthen clinical confidence.
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Contributor: Objective Documentation Protects Patient Access to Home Oxygen TherapyFacing the challenges created by the COVID-19 pandemic, the US medical community has been forced to rapidly change and modernize the manner in which it delivers health care over the last year-and-a-half.
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Advanced Care at Home at Scale in an Integrated Health Care SystemAdvanced care at home (otherwise known as hospital at home) can be scaled and provide care for a sizable portion of a hospital’s inpatient census, creating hospital capacity in an integrated delivery system.
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A Case-Control Study of Length of Stay OutliersLength of stay outliers are associated with hospital-acquired infections, complications, and discharge to facility, as opposed to nonmodifiable risk factors like age and comorbidities.
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Impact of COVID-19 Pandemic on Accessibility of Taiwanese Medical CareThe COVID-19 pandemic disrupted access to routine medical care in community populations in Taiwan. The unmet needs should be emphasized as normal life resumes.
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Effects of Maryland’s All-Payer Model on Elective Joint Replacement SurgeryThe Maryland All-Payer Model was associated with an increase in population-based rates of elective major joint replacements, with a more pronounced effect observed in Maryland-only hospitals.
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Best Practices Drive Better Payer NegotiationsIn today's managed care environment, it is important that contracts between practices and payers include reciprocal language that affords a practice protection over processes, decisions, and changes to the agreement over time, while aligning with its business operation.
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Scaling Care Coordination Through Digital Engagement: Stepped-Wedge Trial Assessing ReadmissionsThis evaluation looks at a postdischarge digital engagement (PDDE) program using causal inference methods to examine the impact of PDDE on readmission.
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Identifying Complex Patients Using Adjusted Clinical Groups Risk Stratification ToolIn this study, the authors developed a method for use in primary care to identify a group of patients with complex care needs using Aggregated Diagnosis Groups.
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Contemporary Care Patterns in the Management of Small Renal MassesAn investigation of management patterns after initial radiographic diagnosis of small renal masses showed that early urologist referral was associated with guideline-concordant care.
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Optimizing Revisit Intervals: Reducing Variability to Enhance Health Care EfficiencyThe authors explore the limitations of the current system of revisit interval assignment and discuss the importance of standardization to optimize patient health care outcomes.
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Collaborative Care Implementation: Lessons LearnedThe authors drafted a “Shared Values of Collaborative Care” document with fundamental principles to make better group decisions in implementing collaborative care.
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Collaborative Care Implementation: Lessons LearnedThe authors drafted a “Shared Values of Collaborative Care” document with fundamental principles to make better group decisions in implementing collaborative care.
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Geographic Variability of Medicaid Acceptance Among Allergists in the USThe proportion of allergists accepting Medicaid in the US varied significantly among and within states.
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Psoriatic Arthritis Treatment Patterns and Costs Among Pharmacologic Treatment–Naïve PatientsWe present results of an analysis of IBM MarketScan databases that evaluates treatment patterns and health care costs for treatment-naïve patients with psoriatic arthritis.
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Future Research Can Guide Employer, Policy Strategies to Improve Workforce Well-Being: Refat Rasul Srejon, MPHRefat Rasul Srejon, MPH, recommends employer coverage for substance use care and follow-up, plus research on local treatment and drug trends.
