Health Care Cost

Timely outpatient telepsychiatry care for Medicaid enrollees was associated with lower hospitalization rates and comparable overall costs, supporting its potential role in value-based care models.

This commentary, part of the Price Crisis campaign, focuses on the role of employers and business coalitions in advocating for policy change.

To mark the 30th anniversary of The American Journal of Managed Care (AJMC), each issue in 2025 includes reflections from a thought leader on what has changed over the past 3 decades and what’s next for managed care. The May issue features a conversation with John Michael O’Brien, PharmD, MPH, a member of AJMC’s editorial board and the president and CEO of the National Pharmaceutical Council. This interview has been lightly edited for clarity.

An executive order signed on Tuesday, March 15, necessitated a change in plans for this panel discussion from the 2025 Community Oncology Conference, with the assembled experts, moderated by Ted Okon, MBA, executive director of the Community Oncology Alliance, speaking to how the order would reverberate across the community oncology space.

Approximately 1 million Aetna members will need new coverage with the announcement that CVS will be leaving the Affordable Care Act (ACA) individual exchange business next year.

Experts urge for technology-driven, collaborative solutions as patients shoulder a growing burden of prescription costs.

Medicaid beneficiaries face higher rates of pulmonary hypertension, with significant economic burdens and racial disparities in prevalence and costs.

When it comes to treating multiple myeloma (MM), Ajai Chari, MD, argued that more is not always better. More intense treatment regimens, or those with more drugs, don't necessarily guarantee better outcomes.

The Trump administration is proceeding with probes into the national security implications of pharmaceutical imports.

Substantial savings opportunities exist by using lower-cost biologics for patients with plaque psoriasis, according to one study.

Asembia's AXS25 Summit will unite more than 8000 key decision-makers to explore pharmacy innovation, artificial intelligence, policy, and patient care from April 27 to May 1 at Wynn & Encore in Las Vegas, Nevada.

Accountable care organizations (ACOs) are increasingly playing the role of data sleuths as they identify and report trends of anomalous billing in hopes of salvaging their shared savings. This mission dovetails with that of CMS, which under the new administration plans to prioritize rooting out fraud, waste, and abuse.

An analysis of an interdisciplinary care model for managing chronic kidney disease (CKD) shows hospital admissions dropped by 26% and emergency department (ED) visits decreased by 30% after clinic initiation.

This week, the Center on Health Equity & Access covered artificial intelligence, diabetes clinical trials, racial disparities in cancer antigen thresholds, and more.

Richard Hughes IV, JD, MPH, spoke about the upcoming oral arguments to be presented to the Supreme Court regarding the Braidwood case, which would determine how preventive services are guaranteed insurance coverage.

The executive order targets lower drug prices through Medicare reforms, anticompetitive crackdowns, and transparency mandates.

From the potential impact of tariffs to the World Health Organization's year-long campaign launch focused on improving maternal and newborn health and addressing preventable deaths, here's the latest from the Center on Health Equity & Access.

A series of new studies from the National Kidney Foundation Spring Clinical Meeting exhibit the association between impaired kidney function and prolonged hospital stays, higher charges, and greater resource utilization.

A new technology for management of diabetes is cost-effective for patients in the US with type 1 diabetes compared with traditional treatments.

Taxing imports to the US could spell major consequences for health care prices, innovation, and access, as a great amount of medical supplies and ingredients are manufactured overseas.

The Center on Health Equity & Access delves into the latest policy shifts, research, and expert perspectives on advancing equity and improving access to care.

In 2021, UnitedHealth Group received 42% of the $33 billion in additional Medicare Advantage payments from differential coding.

Addressing the accessibility and high costs of chimeric antibody receptor (CAR) T-cell and bispecific therapies is crucial for maximizing their impact in multiple myeloma (MM).

The West Health-Gallup Healthcare Indices Study indicates that approximately 29 million people are unable to afford or access quality healthcare, the highest since 2021.

The findings appear as multiple lawsuits pit pharmaceutical companies against hospitals as well as HHS.

This commentary explores the current state, challenges, and potential of artificial intelligence (AI) in health care revenue cycle management, emphasizing collaboration, data standardization, and targeted implementation to enhance adoption.

Mapping care management needs by defining patient populations and then stratifying them according to risk and their needs can help to spur the transformation of a siloed health care system into an integrated system that is able to better provide holistic, value-based care despite the many transitions that continue among hospital, primary, specialty, and community care environments.

Keep up with the latest moves made in health policy under President Donald Trump's second administration. This timeline will be updated as orders and policy progress.

Medication nonadherence to oral anticoagulants and oral anti–prostate cancer medication has been scrutinized through new research conducted among patients and health care providers and presented by the American Medical Group Association at its 2025 annual meeting, held March 26-29 in Grapevine, Texas.

A new Commonwealth Fund report estimates that states' collective gross domestic products would shrink by $95 billion, with total economic output declining by $157 billion.