AJMC® in the Press, January 13, 2023

In the wake of the Inflation Reduction Act and other regulatory changes, Medicare Advantage plans have braced for significant cuts that are forcing them to take a hard look at their product offering.

On this episode of Managed Care Cast, we're talking with the author of a study published in the October 2024 issue of The American Journal of Managed Care® that explored prior authorization decisions in cancer care by race and ethnicity for commercially insured patients.

Program yields largest savings in its history of more than $2.1 billion in 2023.

Delia Orosco, MS, director of Community Wellness Centers at Inland Empire Health Plan, shares insight into innovative initiatives provided by the wellness centers and their new mobile mammogram clinics.

Cost avoidance varied by clinical setting, with the largest savings occurring in hematology clinics ($73,773), followed by rheumatology ($45,330) and pediatric gastrointestinal/irritable bowel syndrome ($16,519).

The Medicaid budget survey for fiscal years 2024 and 2025 revealed state predictions are expecting a decline in Medicaid enrollment and an increase in spending next year due to the end of pandemic-era policies and federal funding.