Insurance

Experian Health’s 2025 State of Claims survey shows rising denial rates, data errors, and low artificial intelligence adoption despite providers’ belief in its potential.

Laxmi Patel urges rural hospitals to align leadership early and build logic models to show how transformation funds can drive access, equity, and sustainability.

Laxmi Patel explains how providers can meet potential new Medicaid documentation requirements without harming patient access.

A RAND report shows Medicare’s 3-year insulin savings model cut costs, improved access for beneficiaries, and offers lessons for future drug pricing reforms.

Laxmi Patel urges hospitals to embed financial screening and simplify payment options to prepare for rising levels of uninsured patients from Medicaid changes.

The program works by embedding Medbridge’s Pathways platform into Marathon’s MoveWell MSK program and advanced primary care model.

Medicare beneficiaries with near low income struggle most with health care affordability, highlighting gaps in financial assistance programs.

Laxmi Patel outlines how Medicaid reforms could raise bad debt, urging providers to strengthen financial counseling, assistance, and price transparency.

Same-sex couples now report higher insurance coverage than different-sex couples, but disparities by income, geography, and marital status remain.

Refat Rasul Srejon, MPH, recommends employer coverage for substance use care and follow-up, plus research on local treatment and drug trends.

Laxmi Patel explains how Medicaid reforms could increase uncompensated care and the burden on hospitals, and how technology can help automate workflows.

Laxmi Patel discusses proposed Medicaid reforms in HR 1, including work rules, coverage limits, and state-level risks for vulnerable populations.

Refat Rasul Srejon, MPH, found that Affordable Care Act (ACA) dependent coverage had mixed effects on young adults’ substance-related emergency department (ED) visits.

A secret shopper survey (N = 8306) in Pennsylvania’s Affordable Care Act (ACA) Marketplace found inconsistencies between carrier regulatory filings and provider directories, frequent inaccuracies in regulatory filings, and challenges in securing timely appointments.

This study of community health workers as clinical extenders demonstrates significant cost savings in managing chronic conditions among Medicaid beneficiaries.

Pulse of the Purchaser 2025 survey results showed the use of transparent PBMs more than doubled in just 1 year, from 12% to 31%.

New guidelines and advocacy enhance myasthenia gravis treatment access, promoting proactive management and improved insurance coverage for diverse patient populations.

Extended hospital stays among Medicare Advantage beneficiaries translated to an estimated 1.8 million additional hospital bed days in 2022.

Many states are enacting restrictions on insurers’ prior authorization policies, but these laws may increase costs and lead to other undesirable consequences.

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 September issue features a conversation with Dora Hughes, MD, MPH, chief medical officer and director of the Center for Clinical Standards and Quality at CMS.

Why is health care so staggeringly difficult to use? How do we fix it? To move forward, we first must look back, because the system we have today was not really designed, it evolved, notes Ariela Simerman, Turquoise Health.

Chris Johnson, MBA, emphasizes that the constantly shifting landscape of Medicaid could further confuse both patients and health care providers, potentially leaving children behind.

Patients with acute respiratory failure who’ve been placed on a mechanical ventilator are less likely to be transferred to high-volume centers if they are uninsured, thus increasing their odds of mortality.

Ravi Vij, MD, MBA, explains how insurance-related delays in CAR T approval slow treatment initiation, increase interim therapy costs, and contribute to patient burden.

Treatment challenges that Anasuya Gunturi, MD, PhD, encounters in her work at Lowell General Hospital include language differences and confusion about scheduled appointments.

Hospital accountable care organization (ACO) participation did not impact emergency department admission rates, length of stay, or costs, suggesting limited effectiveness in reducing spending for unplanned admissions and challenging hospital-led ACO cost-saving strategies.

More large employers with high-deductible health plans with health savings accounts offer preventive drug list benefits over time.

Laxmi Patel, chief strategy officer at Savista, outlines major impacts of the “One Big Beautiful Bill” Act on Medicaid and what hospitals can do to prepare for these changes.

Elise S. Tremblay, MD, MPH, explores potential policy solutions and research directions to address ongoing challenges in insulin affordability and access.

Proposed Affordable Care Act (ACA) premium hikes threaten health care access, with potential increases of over 75% for enrollees.