Policy

To mark the 30th anniversary of The American Journal of Managed Care (AJMC), 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 August issue features a conversation with Charles N. (Chip) Kahn III, MPH, the president and CEO of the Federation of American Hospitals and a longtime member of the AJMC editorial board.

Some hospitals in New Jersey may be eligible for part of the $50 billion CMS spending on rural health care, according to State Sen Vincent Polistina (R, New Jersey).

A new survey reveals widespread consumer frustration with prior authorization, highlighting the need for urgent reform in insurance coverage.

At the recent regional Institute for Value-Based Medicine® event in Boston, Anasuya Gunturi, MD, PhD, Lowell General Hospital, was a panelist for the discussion, “Evolving Breast Cancer Care: Addressing Unmet Needs Across the Patient Journey.”

At the 6-month anniversary of the inauguration in January, The American Journal of Managed Care® looks back at the changes made by the Trump administration that could have lasting effects in health care.

State governments must have budgetary and regulatory flexibility to support health care innovation, says State Sen Vincent Polistina (R, New Jersey).

Thimerosal, a mercury-based preservative, has been incorrectly linked to the development of autism by antivaccine groups.

The Supreme Court decision in Medina v Planned Parenthood South Atlantic and the subsequent passing of the budget bill leave Planned Parenthood clinics and their patients in a precarious spot, says Danika Severino Wynn, CNM.

There is a great need to streamline the process from the tissue sample to the diagnostic lab, whether it's genomic or immunohistochemistry, Robert Kratzke, MD, says.

According to the American Medical Association, blame for the ongoing physician shortage may lie with overly burdensome administrative processes, an antiquated Medicare payment system, and lack of education for residents in primary care and psychiatry.

These interviews are the top episodes, by listens, from among the 21 podcast episodes The American Journal of Managed Care® produced over the first half of 2025. Give them all another listen, and perhaps learn something new.

Sanjay Doddamani, MD, MBA, a former senior advisor to the Center for Medicare and Medicaid Innovation, and internist and cardiologist by training, explains how the Wasteful and Inappropriate Service Reduction (WISeR) Model hopes to work, and addresses concerns about delays and denials from revamped prior authorization processes.

ASCO President Robin Zon, MD, FACP, FASCO, emphasizes how AI solutions and advocacy in enhancing cancer care, ensuring equitable access to innovative treatments for all patients.

Adam Colborn, JD, associate vice president of congressional affairs at AMCP, shares insights on the impact of the Most Favored Nation drug pricing order when it comes to access, affordability, and innovations in US health care.

CMS proposes the 2026 Physician Fee Schedule (PFS), addressing payment disparities in oncology, but the community oncology community warns of financial threats from the Inflation Reduction Act. Updates reflect late Tuesday release of the proposed 2026 schedule for the Hospital Outpatient Prospective Payment System.

During the Reshaping Rx: Navigating 2025 Drug Pricing Policies webinar, panelists discussed the Most Favored Nation executive order, bills aimed at pharmacy benefit managers (PBMs), and other drug pricing policies.

The Trump administration's policies reshape global health dynamics, presenting Europe with both challenges and opportunities for leadership in health governance.

The recent decision in Kennedy v Braidwood could give Robert F. Kennedy Jr, secretary of HHS, the ability to remove all members of the US Preventive Services Task Force (USPSTF) if desired, according to Jeffrey Fitzgerald, JD.

A webinar held by KFF on July 9 emphasized the immediate effects of the new budget bill, highlighting the impacts on Medicaid and health spending in the next decade.

Artificial intelligence (AI) transforms oncology by enhancing clinical decision-making, improving patient outcomes, and shaping future health care training, as discussed by experts at Tennessee Oncology's “Tech Innovations in Community Oncology."

The FDA's new guidance shapes drug development for myelodysplastic syndromes (MDS), emphasizing trial design, patient selection, and safety reporting for better treatment outcomes.

During the “Tech Innovations in Community Oncology” meeting from Tennessee Oncology, oncologists explore artificial intelligence (AI) tools like DeepScribe to enhance documentation efficiency, reduce burnout, and improve patient engagement in clinical settings.

Accountable care organization (ACO) participation was associated with an increase in hospitals’ mean market share and with additional market share gains in more concentrated markets.

Artificial intelligence (AI) transforms oncology by enhancing decision-making, improving patient care, and streamlining operations, while addressing challenges in data accuracy and equity, said speakers at the Tennessee Oncology “Tech Innovations in Community Oncology."

Access to and affordability of immune checkpoint inhibitors, which can be lifesaving if patients receive them on time and under optimal circumstances, continue to top the list of reasons behind outcomes disparities for patients who have private insurance vs those who remain uninsured.

Artificial intelligence (AI) will transform community oncology, addressing workforce shortages and reimbursement challenges while enhancing patient care and operational efficiency, discussed speakers at Tennessee Oncology's “Tech Innovations in Community Oncology."

Precision oncology has entered a new phase, as data sets mature and a new wave of tools emerges to help clinicians manage cancer care over time.

The Braidwood decision maintains the status quo for many patients, keeping preventive services covered by Medicaid under the Affordable Care Act (ACA), says Jeff Fitzgerald, JD.

In a webinar, panelists discuss Trump's 2025 drug pricing policies, focusing on the Most Favored Nation order, pharmacy benefit manager reform, and implications for manufacturers and patients.

Ted Okon, MBA, of the Community Oncology Alliance discusses how community oncology faces a revenue crisis due to the Inflation Reduction Act's impact on Medicare reimbursement, risking patient access to vital cancer treatments.