Managed Care Reflections: A Q&A With Julia Adler-Milstein, PhD

Am J Manag Care. 2025;31(3):In Press

AJMC: How has the relationship between health IT and managed care changed over the years?

ADLER-MILSTEIN: Health IT has always been viewed as an enabler of managed care—from foundational enterprise systems that allow the capture of patient data to advanced analytics that offer insights into how to better manage the quality and cost of care at individual and population levels.

Yet the emphasis of policy and practice efforts to advance health IT in ways that enable managed care has certainly changed over time. We had to spend a lot of time—and money—implementing the enterprise systems and unfortunately still need to invest quite heavily in core infrastructure. Interoperability has also emerged as a really important functionality but one that has been challenging to achieve. More recently we have seen population health analytics and artificial intelligence [AI] tools rapidly mature, which is exciting because they more directly contribute to furthering the goals of managed care.

AJMC: What do you think are the areas of focus that will be necessary to advance the use of health IT going forward?

ADLER-MILSTEIN: Health IT—and especially health AI—governance will come into the forefront. Governance is a broad term but, in this context, it is the function that sits within an organization and brings together strategic goals (what problems are both high priority and best solved by a health IT tool?), funding (what level of investment is required to adopt and use the tool?), and impact (what is the evidence on whether the health IT tool is improving outcomes safely and equitably?). Each of these areas alone is complex, let alone bringing them all together. But without such health IT governance, it is very unlikely that organizations can effectively make use of the explosion of new health IT tools that now exist and will only grow.

AJMC: As guest editor of AJMC’s 2014 Health IT issue, you explained the 3 key themes of the issue as variable health IT adoption across settings, the impact of health IT on important outcomes in terms of patient safety and costs, and the contextual factors that shape the magnitude of health IT’s impact as well as lead to potential unintended consequences.¹ Do you think these themes have remained the same over the past decade, or are there new themes that sum up the status of health IT?

ADLER-MILSTEIN: A blast from the past! These themes feel dated yet also still relevant. They feel dated in the sense that in 2014 we were worried about variable adoption of electronic health records [EHRs] across settings and we have now seen that this concern was largely unfounded. Less well-resourced settings were able to adopt EHRs, but they have lagged in investing in advanced analytic capabilities and likely in AI tools. Similarly, we now have a lot of evidence on the relationship between health IT adoption and cost and quality outcomes, with much heterogeneity and the conclusion that contextual factors matter. Yet the specific formula for success remains elusive and, even with the emerging studies on the benefits of health AI tools, we are seeing a familiar story of inconsistent results. So, my take-home message is that, even as the technologies themselves have evolved, we see the same themes repeating and it feels less surprising and pushes us to dig deeper into the underlying mechanisms that will help maximize value of health IT investments.

AJMC: In addition to serving as a guest editor of the health IT issue, you were also the first winner of the AJMC Seema S. Sonnad Emerging Leader in Managed Care Research Award in 2015.² Could you speak on how your research efforts since then have been inspired by the late Dr Sonnad?

ADLER-MILSTEIN: Being the inaugural recipient of the Sonnad award was one of the greatest honors of my career to date, and I often think about how my work contributes to Dr Sonnad’s legacy. Dr Sonnad’s focus on applying research findings in real-world settings is an inspiration to me and, especially as I have progressed in my career, intellectual inertia is a strong force that I have worked to actively combat. Instead of writing yet another paper on a topic I know well, I’ve tried to push myself into new areas that answer timely questions. As one example, I have recently pursued new work examining how to achieve cross-sector information exchange—moving beyond studying hospitals and practices to the breadth of organizations, including managed care organizations, schools, jails/prisons, and home- and community-based services that all need to be part of health information exchange.

Dr Sonnad was also a committed mentor, and I have been inspired by her focus on training the next generation of managed care researchers. While I am still research active, much of my time—and enjoyment—are devoted to the amazing junior faculty who I am so lucky to work with.

REFERENCES

1. Adler-Milstein J. The 3 key themes in health information technology. Am J Manag Care. 2014;20(Spec. No. 17):SP492-SP493.

2. Adler-Milstein J. Celebrating the impact and inspiration behind bringing value to healthcare. AJMC. October 6, 2016. Accessed January 7, 2025. https://www.ajmc.com/view/celebrating-the-impact-and-inspiration-behind-bringing-value-to-healthcare