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Physiologic insulin resensitization lowers cost in patients with diabetes and kidney disease.
Am J Manag Care
January 2025
McGovern Medical School at UTHealth Houston, 4513 Teas St, Bellaire, TX 77401.
Objective: To examine the effect of physiologic insulin resensitization (PIR) on the cost of treating patients with diabetes and chronic kidney disease (CKD).
Study Design: The mean 1-year cost of treating 66 Medicare Advantage patients with diabetes and CKD who were receiving PIR was compared with that of treating 1301 Medicare Advantage patients with diabetes and CKD not receiving PIR. Differences in disease severity were compared using mean risk adjustment factor scores.
Medicaid managed care network adequacy standards and mental health care access.
Am J Manag Care
January 2025
Department of Population Health Sciences, Weill Cornell Medicine, 575 Lexington Ave, 6th Floor, New York, NY 10022. Email:
Objectives: Medicaid is the largest payer of mental health (MH) services in the US, and more than 80% of its enrollees are covered by Medicaid managed care (MMC). States are required to establish quantitative network adequacy standards (NAS) to regulate MMC plans' MH care access. We examined the association between quantitative NAS and MH care access among Medicaid-enrolled adults and among those with MH conditions.
View Article and Find Full Text PDFTo mark the 30th anniversary of The American Journal of Managed Care (AJMC), each issue in 2025 includes a special feature: reflections from a thought leader on what has changed-and what has not-over the past 3 decades and what's next for managed care. The January issue features a conversation with longtime editorial board member Jan E. Berger, MD, MJ, the CEO of Health Intelligence Partners.
View Article and Find Full Text PDFHealth provider perspectives on establishing service linkages for treatment and follow-up from an Australian, web-based STI testing service: a qualitative study.
Sex Health
January 2025
Melbourne School of Population and Global Health, University of Melbourne, Parkville, Vic, Australia.
Background Web-based, testing for sexually transmitted infections (STI) is becoming increasingly available. However, treatment pathways from web-based services are often not well-coordinated, contributing to treatment delays and access gaps. This study investigated clinician perspectives on building service linkages with a new, web-based, STI testing service in Victoria, Australia.
View Article and Find Full Text PDFMedicare Risk Arrangement and Use and Outcomes Among Physician Groups.
JAMA Netw Open
January 2025
America's Physician Groups, Washington, DC.
Importance: Many physician groups are in 2-sided risk payment arrangements with Medicare Advantage plans (at-risk MA). Analysis of quality and health resource use under such arrangements may inform ongoing Medicare policy concerning payment and service delivery.
Objective: To compare quality and efficiency measures under 2 payment models: at-risk MA and fee-for-service (FFS) MA.
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