November 2025

Based on this analysis, all 3 gepants are not cost-effective compared with usual care for the treatment of acute migraine.

The race of a telephonic care manager did not impact closure rates for gaps in care among Black Medicare Advantage beneficiaries.

Chronic Conditions Data Warehouse comorbidity data vary by insurance status. Analyses using these data that fail to account for insurance status are subject to information bias.

One in 5 of the highest-revenue drugs of 2022 was exclusively approved for rare conditions, accounting for more than 7% of US pharmaceutical spending.

This study examines the clinical settings of first-time psychotic spectrum disorder diagnoses in an integrated health system.

To 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 November issue features a conversation with Laurie C. Zephyrin, MD, MPH, MBA, senior vice president for achieving equitable outcomes at the Commonwealth Fund. This interview has been edited for length and clarity.

Performance on Medicare Star Ratings medication adherence measures is significantly tied to performance on the intermediate outcome and statin process measures.

Medicare Advantage plans that place greater restrictions on home health agency care delivery may have more adverse patient outcomes than plans that provide episodic payments.

For Medicaid care management, focusing on rising-risk patients is more effective than targeting high-cost claimants, whose spending tends to decrease over time due to regression to the mean.

This article provides insights into patterns of health care use following emergency department visits by high-need, high-cost patients with different types of California Medicaid primary care providers.

Clinicians may underassess the need for community-based palliative care among patients with dementia.

A coverage with evidence development (CED) study demonstrated significant and clinically meaningful benefits in patients with migraine treated with remote electrical neuromodulation (REN). Health plans should support clinicians’ REN prescriptions by ensuring adequate coverage.