The Economic Functions of Carve Outs in Managed Care

This survey assesses physician experiences with utilization management and burnout and investigates whether there is a link between them.

Relying on a 2-stage secret shopper survey, the authors found that inaccuracies in provider directories often persisted for well over 1 year.

Proactive care management for artificial intelligence (AI)–identified at-risk patients reduced potentially preventable hospital admissions.

Private negotiated facility fees at hospitals are on average double the ambulatory surgery center facility fees for common outpatient procedures.

The authors detail how artificial intelligence could be used in primary, secondary, and tertiary prevention to improve health outcomes and provide better value-based care.

As the US charts its course through the next political era, it is crucial that we boldly allocate resources and prioritize what truly impacts patients. When faced with complexity, feasibility concerns, or entrenched norms, we must proclaim: “It’s the outcomes, stupid.”