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The authors use surgical resident assignment as an instrumental variable for discharge opioid prescribing and estimate the impact of discharge opioid supply on subsequent use.
Many US patients with diabetes cannot afford their medical care. The authors review the impact of interventions that reduced and/or eliminated diabetes-related costs.
Mortality risk stratification can identify patients at higher risk of mortality and readmissions for prevention strategies. Other patients should be the focus of length-of-stay reduction strategies.
Opioid utilization management in Medicare was associated with mixed effects on opioid prescribing, and prior authorization was associated with a decreased likelihood of subsequent overdose.
Although the vast majority of physicians using an artificial intelligence (AI) scribe perceived a reduction in documentation time, those with the most actual time savings had higher relative baseline levels of documentation time.
Because of its often slowly progressive nature, dementia is often included among chronic disease management programs. Yet, for many reasons, its management demands different approaches.
Findings of this evaluation of primary care clinic responses in a tiered total cost of care benefit design suggest that clinics respond by reducing prices.
A retrospective analysis of 30-day risk-adjusted readmission rates among skilled nursing facilities (SNFs) between 2017 and 2022 compared those that had implemented an interventional analytics platform and other SNFs.
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.
The authors reviewed physician-to-physician conversations during emergency transfer of patients with ST-segment elevation myocardial infarction and found that higher-quality physician coordination was associated with faster time to acceptance.
Patients with activated patient portal accounts report higher patient satisfaction in respective dimensions of the Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) and Hospital CAHPS (HCAHPS) surveys compared with patients without portal accounts.
High-intensity home-based rehabilitation (HIHR) may substitute for facility-based postacute rehabilitation. Patients in HIHR had better functional outcomes at lower costs than patients in facility-based care.
Yuman Fong, MD, City of Hope
Presenters shared their personal highlights of attending ASCO GI 2026.
The foundation of medically integrated pharmacy includes 7 critical pillars. This commentary focuses on the benefits of 3 of those pillars: abandonment, adherence, and access/affordability.
Implementing a proactive provider outreach program resulted in significantly more prior authorization recertifications and a reduction in time to submission.
Real-world adoption of bevacizumab-bvzr biosimilar was retrospectively assessed, revealing switching between biosimilars and the reference product and utilization in extrapolated indications and combination regimens.
The authors interrogate elements of routine medical practice in New York City to argue for reforms of hospital culture through relational trust-building capabilities of community health workers.
Using a microsimulation approach, this study modeled the potential multiyear health and economic benefits of participating in cardiometabolic virtual-first care programs.
The authors developed and validated an accurate, well-calibrated, easy-to-implement COVID-19 hospitalized patient deterioration index to identify patients at high or low risk of clinical deterioration.
This retrospective cohort study evaluated baseline demographics, clinical characteristics, and treatment patterns of US patients with asthma who newly initiated single- or multiple-inhaler triple therapy.
This systematic literature review reports incidence of adverse drug effects associated with guideline-directed medical therapy for patients with heart failure with reduced ejection fraction.
This study evaluated cost and utilization attributed to members enrolled in a health care program with no pharmacy co-pay. Health care savings were identified in addition to medication adherence improvements.
Critical care transition clinic patients with chronic conditions had a 31% reduction in relative risk for inpatient admissions, and the clinic reduced cost by more than $1 million.
In this qualitative investigation, leaders of Medicaid managed care plans were interviewed to identify facilitators of and barriers to electronic consultation for specialty care delivery.
As health care costs rise, especially for patients with complex conditions, a major barrier to access is the disconnect between medical benefits and pharmacy benefits.
For patients prescribed diabetes, hypertension, and hyperlipidemia medications, nonadherence to CMS Star Ratings quality measures of medication adherence was associated with increased health care resource utilization and costs.
This article examines the association between a large-scale primary care redesign—the Comprehensive Primary Care Plus Initiative—and ambulatory care patterns of Medicare beneficiaries with highly fragmented care.
Individuals who became eligible for Medicaid through Medicaid expansion have an increased likelihood of psychiatric readmission compared with their legacy-enrolled counterparts.
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