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Articles

Alopecia profoundly disrupts identity, emotional wellbeing, and social life, with many people struggling due to stigma, concealment pressures, and unmet psychological support needs.

Exploring Identity, Appearance Experiences Among Patients With Alopecia

Oral semaglutide (Wegovy; Novo Nordisk) expands GLP-1 weight-loss options, but pharmacy budgets and health care cost pressures persist.

5 Things to Know About the Oral GLP-1 Era

Mary Caffrey is the Executive Editor for The American Journal of Managed Care® (

®). She joined AJMC® in 2013 and is the primary staff editor for 

the multistakeholder publication that reaches 22,000+ oncology providers, policy makers and formulary decision makers. She is also part of the team that oversees speaker recruitment and panel preparations for 

®'s premier annual oncology meeting, Patient-Centered Oncology Care®. For more than a decade, Mary has covered ASCO, ASH, ACC and other leading scientific meetings for 

Mary has a BA in communications and philosophy from Loyola University New Orleans. You can connect with Mary on 

A study from Sweden, the largest of its kind, challenges the standard 24-month milestone as the key point when early relapse is a concern.

Even After 6 Years, Disease Progression Impacts Survival in Mantle Cell Lymphoma

Study links elevated serum haptoglobin to chronic spontaneous urticaria activity, suggesting it predicts treatment response and complete disease control.

Potential Predictor of Treatment Response in Chronic Spontaneous Urticaria Identified

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Compendium

Reimbursement

On this episode of Managed Care Cast, we dive into 

, or RTM, a topic of great interest in the physical rehabilitation industry. We are joined by Donovan Campbell, CEO of Medbridge, a leading provider of physical therapy education, currently serving approximately 360,000 clinicians and supporting 15 million patients annually.

 as part of the Calendar Year 2026 Physician Fee Schedule (CMS-1832-P), recognizing that RTM is critical for supporting physical therapy, patient health, and patient engagement. At its core, RTM is the fusion of in-person care with convenient, digitally provided care—a core component of what is known as hybrid care.

With CMS proposing new codes that materially 

—including the potential shift to allowing billing after just 2 days of data transmission—RTM has the opportunity to move from a niche category to a mainstream model of care delivery.

We will explore how this shift provides a crucial financial incentive for organizations, but more importantly, how the successful adoption of RTM enhances the clinical value proposition by improving population health, lowering overall costs, and tackling the problem of access barriers to conservative care.

Listen above or on one of these podcast services:

Medbridge is working to refine remote therapeutic monitoring, or RTM, to transform physical therapy and enhance patient care.

From Niche to Mainstream: Transforming Physical Therapy by Refining Remote Therapeutic Monitoring

On this episode of Managed Care Cast, we're talking with the University of Minnesota School of Public Health's Hannah Neprash, PhD; John Mulcahy, a PhD candidate; and Ezra Golberstein, PhD, the authors of a study published in the March 2024 issue of 

The Extent and Growth of Prior Authorization in Medicare Advantage

," discusses how the service-, area-, and carrier-level patterns they identified suggest variation in how Medicare Advantage plans use prior authorization.

On this episode of Managed Care Cast, we're talking with the authors of a study published in the March 2024 issue of The American Journal of Managed Care® about their findings on variations in prior authorization use across Medicare Advantage plans.

Exploring Medicare Advantage Prior Authorization Variations

Drs Emeline Aviki and Sephen Schleicher speak with Debra Patt, MD, PhD, MBA, Texas Oncology

Oncology Onward: A Conversation With Dr Debra Patt of Texas Oncology

Debra Patt, MD, PhD, MBA, executive vice president of policy and strategic initiatives and director of public policy at Texas Oncology, joins hosts Emeline Aviki, MB, MBA, medical director and attending surgeon at NYU Langone Perlmutter Cancer Center, and Stephen, MD, MBA, chief medical officer at Tennessee Oncology, for episode 2 of our newest podcast, "Oncology Onward: Conversations With Innovators and Changemakers in Cancer Care."

Patt is a policy and physician expert, breast cancer specialist, and board member of the Community Oncology Alliance and American Society of Clinical Oncology. Her in-depth conversation with Aviki and Schleicher addresses several important issues currently affecting high-quality oncology care: most important, the current drug shortage, and the economics that made it a problem, innovative ways to fix it, and economic solutions to prevent it from perpetuating.

They also discuss the instability of drug pricing—wholesale acquisition cost vs average sales price—the relationship between cancer and aging, pharmacy benefits managers and how they have affected the price of cancer care, and facilitating meaningful change for patients.

Debra Patt, MD, PhD, MBA, joins hosts Emeline Aviki, MD, MBA, and Stephen Schleicher, MD, MBA, for episode 2 of our newest podcast, "Oncology Onward: Conversations With Innovators and Changemakers in Cancer Care."

Collaborative care use has surged 26-fold, but state reimbursement gaps leave many patients without integrated mental health care in primary care.

Use of Collaborative Care Grows Rapidly, Uneven Medicaid Coverage Drives State Gaps

The ACCESS Model signals a shift toward outcome-aligned payments and a necessary reframing of what “value” actually means.

Contributor: Value-Based Care Needs a Rebrand. Will 2026 Be the Year It Finally Gets One?

AI revolutionizes pharmacy by automating workloads, enhancing patient care, and navigating drug pricing challenges amid evolving federal policies.

ICYMI: Highlights From Asembia’s AXS25 Summit

The most-viewed content focused on the “One Big Beautiful Bill,” the Most Favored Nation drug policy, and other changes under the Trump administration.

Automating processes can help to prevent avoidable losses of coverage: William Schpero, PhD, MPhil, MPH

William Schpero, PhD, MPhil, MPH, from the Weill Cornell Graduate School of Medicine, spoke about how automating the implementation of the Medicaid work requirements, set to go into effect in 2027, could help to mitigate avoidable loss of coverage at the state and federal level.

This transcript has been lightly edited for clarity; captions were auto-generated.

Is there anything that can be done to mitigate the effect of the Medicaid work requirements?

I think there are a number of steps that could be taken for the federal and state levels to mitigate coverage losses, to prevent avoidable losses of coverage as a result of the implementation of work requirements under the One Big, Beautiful Bill Act. At the federal level, I think there are really 2 important steps. One is, I already mentioned that states have this really short timeline to ensure compliance: about a year and only 6 months following the release of the specific regulations that outline how work requirements should be implemented next summer. I think if Congress were to go ahead and extend that deadline for states, that would allow states to ensure that all their systems are set up as well as possible to mitigate avoidable losses of coverage. To be clear, the law does allow states to apply for an extension. So they can apply for up to a 2-year delay in implementing requirements if they demonstrate good faith efforts to meet the original deadline. But I think even really automating that, where states get an additional year or 2 to ensure compliance, could go a long way to reducing the burden on states, allowing them to develop some best practices, share those best practices, ensure they're doing everything they can, again, to mitigate avoidable losses of coverage.

I think also, as I mentioned at the outset, a lot of folks will qualify for exemptions. I think if the regulations are written in a way that gives states more leeway in terms of how those exemptions are defined, allowing states to be more generous in implementing those exemptions, we know that will go a long way toward mitigating coverage losses, given that we think most people in this population are working, and it's not that they would lose coverage because they're not working but because of the barriers associated with reporting and demonstrating compliance with with the law. I think those are all things that can be done at the federal level.

I think at the state level—and I know states are really invested in this right now—doing everything they can to sort of automate processes so that, for as many people as possible, the state can pull from existing data sources, whether it be state wage data or data from other programs like the SNAP program, the food stamp program, where the state already has information on folks' income or work status. The more the state can do to automate work reporting, the more states can also do to automate exemptions. Pulling from claims data, from clinical data, information on whether folks will qualify on the basis of their clinical characteristics or other observable characteristics. The more the state can do to ensure that folks don't have to report on their own to be compliant with the law, the better. That, again, is something I know states are very focused on that will go a long way toward mitigating avoidable losses of coverage.

Also, the more states can do to reduce reporting friction, for some segment of folks, states won't be able to automate reporting—they'll have to ask for more information. The more states can invest in really easily accessible portals, folks that engage in outreach to help people report, and then more broadly just outreach and engaging with community based organizations, provider organizations, other folks who are regularly engaging with this population of Medicaid enrollees to get the word out and to provide some clear direction on how they can ensure they're compliant with the law so they don't lose their coverage.

Videos

Avoiding losses of coverage due to administrative barriers can be done with a focus on making some of the processes automatic.

Automating Processes Can Help Prevent Avoidable Losses of Coverage: William Schpero, PhD, MPhil, MPH

Zachary speaks about the effect of ACA subsidies ending and work requirements starting in terms of insurance coverage

Discontinuation of ACA subsidies will leave many uninsured: Ciara Zachary, PhD, MPH

Ciara Zachary, PhD, MPH, assistant professor in the Department of Health Policy and Management at the Gillings School of Global Public Health at the University of North Carolina, explained how many individuals would be left uninsured if the Affordable Care Act (ACA) subsidies are not extended. Combined with the introduction of work requirements to be eligible for Medicaid, this could leave more than 10 million without insurance and bring the country back to pre-ACA levels of insurance coverage.

What will occur if both the ACA subsidies end and the work requirements go into effect in 2027?

I think the immediate concerns are about the subsidies and the additional financial help that these subsidies had. I think we are seeing lots of reporting, whether that is from media outlets or other health policy researchers, just predicting that the price of premiums is just going to skyrocket and making health care just unaffordable for so many folks who've become reliant on the ACA, because it is comprehensive care, it is more affordable, and you kind of take that away. And thinking about other economic priorities that folks have, we hear a lot about the price of groceries, putting gas in your car, other things that people have to do just to maintain their livelihood. 

I, unfortunately, think that some people might try to forego health care. And especially some of our healthier folks who might not have complex or extreme health needs, they may say, "I don't need health care." And we know what this can do to the risk pool and perhaps some destabilization of the marketplace that could further increase costs down the line. If the subsidies are not extended, we know that we'll immediately see a significant surge in the number of uninsured. Then, when you add that to the Medicaid work requirements, and how many folks may lose coverage just because of paperwork, not even deeming them ineligible, we may get to pre-ACA levels of the percentage of folks who are uninsured in this country. And I think some folks may think we might even exceed that number.

The uninsured rates may skyrocket when Medicaid work requirements go into effect and if the Affordable Care Act (ACA) subsidies are not extended.

Discontinuation of ACA Subsidies Will Leave Many Uninsured: Ciara Zachary, PhD, MPH

Schpero discusses the strain on the system that Medicaid work requirements will cause

System strain likely with Medicaid work requirements: William Schpero, PhD, MPhil, MPH

William Schpero, PhD, MPhil, MPH, from the Weill Cornell Graduate School of Medicine, explained that new responsibilities for state Medicaid offices will strain the system as they look toward implementing the Medicaid work requirements by 2027.

This transcript has been lightly edited for clarity; captions are auto-generated

Could the system be stressed by the increase in paperwork related to Medicaid work requirements?

I've talked a lot with states that are, right now, heads-down trying to implement the systems [and] the changes they need to ensure their compliance with the law and with the expectation that they implement work requirements. I'm hearing across the board this is a Herculean task for them. They have to invest in really significant changes to their enrollment and eligibility systems, to their data infrastructure, to try to ensure that they know if someone is working or if someone is not and that they can do their best to automate a lot of the reporting requirements to reduce the administrative burden associated with being compliant with the law. They're investing a ton in IT infrastructure. They're also trying to staff up at a time when they face major challenges staffing in the wake of the pandemic. There are, I think, really huge burdens on states to really implement all the changes they need to make ahead of the start of work requirements on January 1, 2027. 

This is a really short timeline for states. They have, effectively, a year to be compliant with the law. What further complicates this is, even though the states have the language of the law, the statutory language as outlined by Congress, the regulations that indicate very specifically what they need to do to be compliant won't be released by the federal government until next summer. Really, there are only 6 months that states have following the release of those regulations to ensure that they've done everything correctly by the letter of the law. I think the timeline, along with the large IT enrollment and eligibility and infrastructure-related changes states need to make, puts a real burden on them and it's going to get very difficult for them to ensure that no one falls through the cracks.

The quick turnaround between the introduction of Medicaid work requirements and implementation could leave many states spread thin, explains William Schpero, PhD, MPhil, MPH

System Strain Likely With Medicaid Work Requirements: William Schpero, PhD, MPhil, MPH

Zachary discusses troubled history of work requirements for Medicaid coverage

Medicaid work requirements mirror programs in Georgia, Arkansas: Ciara Zachary, PhD, MPH

Ciara Zachary, PhD, MPH, assistant professor in the Department of Health Policy and Management at the Gillings School of Global Public Health at the University of North Carolina, discussed what the work requirements introduced in the One Big Beautiful Bill Act will mean for those who receive their coverage through Medicaid, including how work requirements had been attempted in states like Georgia and Arkansas.

Can you explain the Medicaid work requirements and who stands to be the most affected by this change?

These work requirements from the House Reconciliation or HR 1 will really target our Medicaid expansion population. If we all recall, one of the critical provisions of the Affordable Care Act was to expand Medicaid for adults under age 65 up to 138% of the federal poverty level. For some of these folks, there's a tendency to be on 2 different sides of the coin. Some folks believe everyone deserves access to health care. Others believe that some folks are more deserving than others. And so with this expansion population, we're kind of thinking, if these are adults, many of whom are not caregivers or parents, that they should be working. So that is kind of what's behind the work requirement. 

This would require folks in the Medicaid expansion population to prove that either they are looking for a job, working, or maybe participating in some kind of educational or skill-building activity for about 80 hours a month, and the states would have to determine whether folks are meeting these benchmarks or proving that they've had 80 hours of work a month, I believe every 6 months, to determine whether they are still eligible.

Many people say that what was in the Big Beautiful Bill Act with work requirements is kind of modeled after what's happening in Georgia. Now, I believe they have a program with work requirements called Pathways to [Coverage], and that's kind of the thing. They are working 80 hours a month and having to submit paperwork. 

I think what's important to note is that the GAO [Government Accountability Office] report from September about the Georgia Pathways work requirement, and even what we knew a few years ago during the first Trump administration when Arkansas briefly had work requirements, is that it makes it harder for people to get Medicaid coverage. And it actually is an extreme administrative burden and costly administrative burden. So I would say those are the main points: that it's actually not really going to increase access to care, and it's actually going to create lots of barriers for those who would be eligible in that Medicaid expansion population, but also create just administrative burden for states.

Requiring individuals on Medicaid to report their work hours has been attempted in other states previously, with mixed results.

Medicaid Work Requirements Mirror Programs in Georgia, Arkansas: Ciara Zachary, PhD, MPH

Johnson emphasizes building trust with patients to ensure that any confusion surrounding the Medicaid cuts is mitigated

Rebuilding trust in medical care is paramoutn as children potentially lose Medicaid coverage: Chris Johnson, MBA

Chris Johnson, MBA, CEO and founder of Bluebird Kids Health, spoke about the importance of building trust with children and their parents as the country faces Medicaid cuts that could affect families across the country. Establishing that trust, he said, will help to get children who need care to the doctor's office so that they do not needlessly lose their coverage due to confusion from the family.

This transcript has been lightly edited for clarity; captions are auto-generated.

What can be done to help children losing Medicaid coverage?

Absolutely, we need to relentlessly advocate for children to be able to have access to high-quality, trusted pediatric care in the country [and] across the country. There's a few very tactical things that I think are going to be really important. 

, there's a lot of change coming. I think a lot of folks who are eligible for care are going to be almost locked out of the system due to administrative bureaucracy and confusion, and we need to keep working to reduce that. I don't know if you or others have worked directly sometimes with Medicaid agencies; they tend not to be super well resourced. The guides on how to do things are very confusing and complex. Being able to simplify that experience, and I think using it as our goal to make sure all folks who are eligible are getting services be the mindset is incredibly important for us, especially for children. Especially for vulnerable children, many children in foster care, that are covered by Medicaid. We really need to make sure that those barriers are low.

And then the second thing that I think is really important is, we need to keep building trust with children and families. I think that a lot of really well-intentioned public health things have happened over the last 4 or 5 years, but there were some areas where we were wrong, and I think we need to own where mistakes were made in order to continue to build trust behind a lot of the really deeply validated outcomes we can drive that are science-backed in children's medicine. Because we need to keep welcoming people into the system. We need to let them know that we can be trusted, and we need to be, I think, humble on areas where maybe we, with the best intentions, foot faulted, here or there, over the last several years to rebuild that trust.

The one other thing I'd add is, alongside the changes in the One Big, Beautiful Bill, there [are] also a lot of changes happening around like preventative services in the US that are happening. It's outside of the bill, but it's happening in parallel, {and] that really is a very direct impact on children's health. And tied to the last point I was just making around trust, I think we need to make sure that we're continuing to build trust, we're continuing to advocate for doing what's right for folks, and we're continuing to meet folks where they are and agreeing where has science been solved, and making sure that we're advocating for that and being open about if we've made mistakes in the past, acknowledge that and move forward.

But that's the other really hard thing in pediatric care today, is there's some valid criticisms of certain aspects of care, but there's a lot of questioning of what really is kind of resolved science, with decades of evidence that shows it's really transformative for the health of children in our country. And so it's really important for me that we continue to advocate for that and for doing what's right for the next generation of kids so that we can continue to thrive as a country.

Making sure that children have access to high-quality care and parents trust that care is important in making sure that children are cared for after Medicaid cuts take effect.

Rebuilding Trust in Medical Care Is Paramount as Children Potentially Lose Medicaid Coverage: Chris Johnson, MBA

Johnson talks about health care deserts that may be exasperated with the cuts to Medicaid

Medicaid cuts could cause legislators to reevaluate access to care for children: Chris Johnson, MBA

Chris Johnson, MBA, CEO and founder of Bluebird Kids Health, spoke about how health care deserts exist all over the country in both rural and urban settings, which makes access to care an important issue for children living anywhere. This, he says, provides an opportunity to see how access to care can improve and implement them through legislative action.

Are there ways to help health care centers, particularly in medical deserts, who will have fewer funds from Medicaid going forward?

I think there are. I think it's going to require us to continue to innovate and think more about community-based ways to access health care for all Americans, but especially for children. Those health care deserts that you mentioned, they exist in Florida [and] they exist, actually, in just about every major metro area across the country.

I think there are real challenges with rural health. I know there's some funds in the bill that are trying to prop up rural health, but there's actually a challenge in children's health that exists in every single metro area across this country, where, if you look at the 50% highest income zip codes vs the 50% lowest income zip codes and you normalize for population, you see about a 2 to 1 differential in number of pediatricians per 1000 children. That means that children in all cities across the country are struggling to get access to high-quality pediatric care, and that's the care that keeps them out of the hospitals.

The hospitalization rates that you often see for children on Medicaid can be 6 or 7 times the rates of children on commercial coverage, and these are entirely avoidable emergency room visits, entirely avoidable inpatient stays that are incredibly high cost for our health care system, and they're incredibly low quality because kids shouldn't be receiving primary care services in those care settings.

I think the big innovation that this could unlock is, how do we get more community-based providers? How do we get more pediatricians closer to children? How do we democratize access to care? I like to think of that as maybe a silver lining. Can we use some of this legislation to actually open up more access points for those kids where we're getting higher quality outcomes at a lower cost of care?

Boston is my hometown, and it's a very dense place. If you live in Boston Beacon Hill, you have great access to health. You probably have too much access to health care if you live in Beacon Hill. But if you live just 10 miles south, in South Boston, Dorchester, [or] Mattapan, you actually have a lot of struggles getting access to high-quality care.

Even in really dense areas, even in really high-income cities, we still see these really big disparities and access to care that are so important for children. Children's health in this country—one of the great things is we've generally agreed that children should get access to health care regardless of their circumstances. That's my glass-half-full view of 50% of kids [being] covered by Medicaid and CHIP [Children's Health Insurance Program]. The great things we also cover services that are all about setting up children to thrive throughout the rest of their life. We cover preventative screens. We incentivize providers to provide high-quality care and have folks come in for annual wellness visits. We invest in vaccinations that we know prevent these really horrible, debilitating diseases like polio. I think it's really amazing that we do that, and we just have to, as a system, make sure that the care delivery apparatus that I'm a part of gets and finds those kids and brings them into the system.

Medicaid cuts could be devastating to areas where health care deserts are prevalent, especially in children, making it vital that legislators understand the potential gap in care to help close it.

Reimbursement

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