Authors
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Mental Health Service Utilization Review Patterns in a Medicaid Managed Care ProgramMedicaid managed care utilization review data for mental health services were analyzed for the calendar years 2017 and 2018. These data indicate low rates of utilization review denials for both inpatient and outpatient mental health services.
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Varied Access: The Pharmacogenetic Testing Coverage DivideOn this episode of Managed Care Cast, we speak with the author of a study published in the February 2025 issue of The American Journal of Managed Care® to uncover significant differences in coverage decisions for pharmacogenetic tests across major US health insurers.
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Hypoglycemia Upon Hospital Admission From Long-term Care: Health Care Resource UseThis analysis of a hospital billing database describes inpatient length of stay, intensive care unit length of stay, comorbidities, and costs for patients with diabetes after admission with hypoglycemia from long-term care or home.
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Outcomes in Patients With IBD Stratified by Risk of Disease ProgressionThis study validates criteria to identify patients with inflammatory bowel disease (IBD) at risk of worsening disease who may benefit from early treatment with advanced therapies.
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We Need to Act Earlier to Address the Silent Crisis of Kidney Disease, Inadequate Federal SupportThe author discusses a program to prevent kidney decline and progression to dialysis by offering education, support services, and help navigating the health care system to those most at risk.
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Managed Care COVID-19 Outcomes in a Population Health ProgramData from 38,193 patients showed that managed care patients have COVID-19 risk factors similar to those of the general population and that a population health program decreased mortality.
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Growth of Electronic Consultations in the Veterans Health AdministrationThis study evaluates the growth in electronic consultation use over the first 7 years after its implementation across the entire Veterans Health Administration system.
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Impact of Co-pay Assistance on Patient, Clinical, and Economic OutcomesLimited evidence from a literature review suggests that co-pay assistance was associated with improved treatment persistence/adherence across various diseases, with indirect evidence suggesting improvements in clinical outcomes.
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Cost-Effectiveness of a Multicancer Early Detection Test in the USMulticancer early detection testing results in extended life-years and reduced cancer treatment costs through earlier diagnosis, leading to a cost-effective option in cancer screening.
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Community Health Workers’ Critical Role in Trust Building Between the Medical System and Communities of ColorThe 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.
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Cost Savings Associated With a Web-Based Physical Activity Intervention for COPDThe authors modeled costs associated with a pedometer-based, web-mediated physical activity intervention compared with a pedometer alone for chronic obstructive pulmonary disease (COPD) management. The intervention was cost-saving.
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A Data-Based Foundation for Managing Hypertension ServicesAnalysis of more than 16 million visits for hypertension care suggests that a large fraction of face-to-face care is low value and could be provided differently or potentially eliminated.
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Clinical Outcomes in Heart Failure Monitoring: A Pooled Rates AnalysisThis systematic literature review and pooled rates analysis investigated the standard of care for patients with heart failure in the US post hospital discharge.
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Medicare Coverage of Buprenorphine-Naloxone Film Surrounding Generic EntryMedicare plans are replacing brand-name buprenorphine-naloxone film with its generic equivalents, resulting in a decrease in out-of-pocket cost faced by enrollees with opioid use disorder.
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Geographic Variability of Medicaid Acceptance Among Allergists in the USThe proportion of allergists accepting Medicaid in the US varied significantly among and within states.
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The Role of Advanced Technologies in Improving Diabetes OutcomesThis article reviews underlying barriers to health care access and discusses how a value-based diabetes care model could improve patient outcomes and reduce long-term costs.
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Avian Influenza: Prevention, Progress, and Public Health PrioritiesTo learn more about the recent bird flu outbreaks, we spoke with Asha Shah, MD, director of infectious diseases and epidemiologist at Stamford Hospital.
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Using a Brief Tool to Assess Healthy School Environments: A Pilot StudyThe authors evaluated a brief assessment tool that accountable care organizations can use to help elementary schools improve student nutrition and increase physical activity.
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Patients’ Access to 2018 FDA-Approved Drugs 1 Year Post Approval2018 was a landmark year for new drug approvals. However, patients’ access to these novel drugs varied by drug category and enrolled health plan.
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A Novel Approach to Attribute Responsible Physicians Using Inpatient ClaimsThe authors propose a novel approach in which physicians’ responsibility for inpatient stays is expressed through physician-specific attribution ratios informed by patient characteristics.
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Social Determinants of Health and High-Cost Utilization Among Commercially Insured PopulationResidence in a more disadvantaged neighborhood was associated with higher likelihood of being a high-cost utilizer among older adults and lower likelihood among younger adults.
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How English- and Spanish-Preferring Patients With Cancer Decide on Emergency CareCare delivery innovations to help patients with cancer avoid emergency department visits are underused. The authors interviewed English- and Spanish-preferring patients at 2 diverse health systems to understand why.
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Challenges With Implementing the Diabetes Prevention Program for Medicare Beneficiaries in an Integrated Health SystemThis study presents challenges of implementing the CDC-approved Diabetes Prevention Program for Medicare beneficiaries at a large, integrated health care delivery system.
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Utilization of Low- and High-Value Health Care by Individuals With and Without Cognitive ImpairmentLow-value service utilization is common among all older adults, and utilization of some high-value services decreases after the onset of cognitive decline.
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Physician Preferences for an Electronic Lung Cancer Screening Decision AidThis qualitative study on primary care physicians yielded suggestions that can inform the design of an effective lung cancer screening decision aid tool and implementation into the electronic health record.
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Doctors Hate Deductibles: Physicians Pay Thousands to Avoid High DeductiblesNinety percent of physicians did not select a high-deductible health plan although it would save them $1500 to $4000 per year regardless of health spending.
