Insurance

Within the same physician groups, 2-sided risk in Medicare Advantage (MA) was associated with higher quality and lower utilization for dually eligible beneficiaries compared with fee-for-service MA and traditional Medicare.

Medicare Advantage beneficiaries with mental health diagnoses see more nurse practitioners and fewer internal medicine and emergency medicine specialists after switching to traditional Medicare.

Shared savings reflects continued growth of long-term-care ACOs in Medicare’s value-based models.

The expansion of direct-to-consumer (DTC) pharmaceutical manufacturer models and the upcoming TrumpRx launch offer lower costs but create new complexities for patients.

Adam Brufsky, MD, PhD, addresses how the COVID-19 pandemic affected breast cancer screening rates across Pittsburgh.

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

Targeted financing, clinician recruitment, and telehealth expansion are needed to improve rural primary care.

Cuts to Medicaid could spell trouble for pediatric health, as millions of children rely on Medicaid to cover their hospital expenses.

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.

Experts say proposed pharmaceutical tariffs could raise drug prices, impacting patient access and health care budgets.

A vote on the House floor allowed for the government to reopen immediately, but the fight over the extension of ACA subsidies still goes on.

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.

Utilizing the Health Insurance Disparities Index for assessment, the authors found that New York’s Medicaid health maintenance organizations (HMOs) outperformed Medicaid HMOs nationally in addressing health care disparities from 2019 to 2023.

Only 4% of NIH prevention projects target health disparities, revealing a major gap between equity research and real-world implementation.

The introduction of more stringent work requirements for those enrolling or renewing their Medicaid coverage can affect both children and adults.

Aligning patient and insurer incentives through price transparency, lower out-of-pocket costs, and broader networks could boost ASC use and access.

Oncology experts at PCOC 2025 discuss breakthrough therapies, AI-driven care, and evolving care delivery models shaping the future of oncology.

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.

Patients save most on outpatient surgeries at in-network sites, so Xiaoxi Zhao, PhD, emphasizes that transparency could help them make better cost choices.

UPMC's pilot program reveals how social determinants of health impact food access and blood sugar management, challenging traditional health care assumptions.

In-network ambulatory surgery centers are cheapest, while out-of-network hospital outpatient departments nearly double costs, says Xiaoxi Zhao, PhD.

As open enrollment begins November 1, 2025, millions are signing up under enhanced subsidies that are set to expire at the end of this year.

Individuals with both low incomes and health problems were more likely to gain employment when covered by Medicaid.

Kimberly Westrich, MA, discusses how patient engagement can revolutionize health care decision-making and break down barriers to accessing necessary medicines and care.

PBM legislation is rising nationwide, which experts emphasize could increase costs and hinder patient care.

Premiums for coverage on the ACA marketplaces are set to jump by an average of 26% next year, even before the expiration of subsidies is factored in.

The antiretroviral (ART) regimen Biktarvy showed higher 1-year ART persistence and lower switch rates among people with HIV.

In the midst of a government shutdown, former House Speaker Paul Ryan urges clear policies, AI innovation, and patient-focused solutions to build a sustainable US health care system.

AI can transform health care by processing vast data, enhancing decision-making, and addressing biases, but needs remain for transparency and human oversight.

Ratna Kiran Bhavaraju-Sanka, MD, and Beth Stein, MD, advocate for improved proactive management of myasthenia gravis (MG) for better patient outcomes.