February 2025

To mark the 30th anniversary of The American Journal of Managed Care (AJMC), each issue in 2025 includes reflections from a thought leader on what has changed over the past 3 decades and what’s next for managed care. The February issue features a retrospective by Richard J. Gilfillan, MD, former director of the Center for Medicare and Medicaid Innovation; and Donald M. Berwick, MD, MPP, former administrator of CMS.

This letter discusses previously published research that paves the way for deeper exploration of the ethical and human aspects of artificial intelligence in health care.

This analysis demonstrated significant variability in medical policy determinations and evidence cited for clinically relevant pharmacogenetic tests among major US health insurers and laboratory benefit managers.

Dementia was more prevalent in older patients with some cancer types, and comorbid dementia in this population was associated with unplanned or unnecessary hospitalization.

Longer appointment duration was associated with lower likelihood of missed appointments for patients receiving care at a federally qualified health center network.

Relying on veteran survey responses and novel actuarial data, the authors examine the relationship between benefit value and reliance on the Veterans Health Administration.

Thirty-day episodes of care initialized by emergency department visits can inform future quality improvement efforts.

This study examines the impact of geographically limited disasters on health care quality performance scores of Medicare Advantage contracts, finding limited impact on performance scores.

The Comprehensive Care for Joint Replacement Model mitigated a trend of lower home health uptake for Black and White patients but not for other populations.

A polysocial risk score is a potentially useful addition to the growing methodologies to better understand and address health-related social needs.