Policy

A new review article explains the role of biologics in treatment systemic lupus erythematosus (SLE) and lupus nephritis.

COVID-19–driven telehealth exposure positively shifted physician respondents’ perceptions of telehealth effectiveness, and most are likely to continue use if temporary telehealth regulatory flexibility is permanently extended.

State surprise billing protections decreased emergency department (ED) out-of-pocket payments to such an extent that ED visits actually increased.

David E. Koren, PharmD, MPH, BCPS, AAHIVP, FIDSA, infectious disease clinical pharmacist at Temple University Hospital, provides an update on current preventive efforts to address the monkeypox public health emergency in the United States and what steps are needed to protect at-risk populations.

Using systemic corticosteroids (SCS) to treat chronic rhinosinusitis with nasal polyps (CRSwNP) has been linked to adverse outcomes among patients, prompting these study investigators to compare their health care resource utilization with that of patients who have CRSwNP but don’t use SCS.

This article presents a detailed descriptive analysis of how Massachusetts and Minnesota implemented Medicaid accountable care organization (ACO) models for their managed care population.

Following a recent update to the diagnostic criteria for borderline pulmonary hypertension (PH), which is often associated with left heart failure (LHF), outcomes among patients with both conditions remain uncertain.

The authors describe a pay-for-performance initiative targeting behavioral health providers, which was introduced by a large Medicaid managed care organization across multiple states.

An editorial in response to the editor in chief’s December 2021 letter discusses alignment of specialist physicians with value-based care initiatives.

CVS announces its plan to buy Signify Health for $8 billion; government budgets and low reimbursement could limit the ability for new moms to stay on Medicaid for a year after childbirth; the long-lasting symptoms of COVID-19 could be keeping millions of people out of the workforce.

Medication-at-home pharmacy is an innovative method of medication management that is vital to the success of the health care system.

Understanding if local prescription patterns are influenced by guidance could help policymakers understand what is needed to further encourage a shift to asthma inhalers with less of a climate impact.

Do-it-yourself (DIY) automated insulin delivery systems have gained rapid uptake, yielding self-reported improvements in glycemic control and quality of life for patients, but creating unique challenges for health care providers (HCPs).

Patient confidentiality is a major reason why minors do not seek out prevention, testing, and treatment services for sexually transmitted infections (STIs) and HIV.

The FDA is considering Pfizer/BioNTech’s request for its updated COVID-19 booster; California Governor Gavin Newsom rejects bill allowing supervised injection sites; a new report from the CDC shows 2019-2020 life expectancy fell in all states.

As Medicare Advantage increasingly becomes the dominant form of Medicare coverage, Congress must improve transparency of programmatic costs and benefits to promote beneficiary choice.

On this episode of Managed Care Cast, we speak with the author of an article in the August issue of The American Journal of Managed Care® about the premium tax credits for health insurance purchased through the health care marketplace, which were recently extended for another 2 years with the signing of the Inflation Reduction Act.

The year of application predicts discharge from the Department of Veterans Affairs (VA) caregiver program. Unexpected, disallowed criteria also predict discharge, with significant others facing higher discharge risk than spouses.

This study investigated how an initial diagnosis influences delivery of second opinions concerning skin cancers, including the possibility of an incorrect diagnosis.

When the pandemic public health emergency eventually ends, so will the various waivers and regulatory flexibilities enacted by HHS during the COVID-19 pandemic, including the ability to provide acute hospital care at home, unless Congress acts.

Policy observers and industry stakeholders debate the possible spillover effects of Medicare drug pricing reform in the employer-based insurance market; a California federal judge rules Walgreens could be held liable for not investigating suspicious orders of opioids in San Francisco; a blood test performed the day of a traumatic brain injury (TBI) can predict which patients may die and who may survive with a disability.

In this episode of Managed Care Cast, we speak with Sachin Jain, MD, MBA, SCAN Group and Health Plan's president and CEO, about how the organization made 10% of senior managers’ annual bonuses dependent on how well the gap in medication adherence among diverse populations was reduced.

We estimate that the median 2021 premium tax credit for off-marketplace enrollees in California would be $311 if they switched to marketplace plans, with wide variation by age and plan size.

HR 5376, or the Inflation Reduction Act, is most significant piece of legislation affecting federal health policy since the passage of the Affordable Care Act in 2010; for Medicare beneficiaries, it caps insulin at $35 a month and includes other pricing reforms.

Medicaid expansion was associated with substantial changes in Medicaid managed care plan composition, which may influence a plan’s performance on enrollee experience metrics.