American Journal of Managed Care最新文献

{"title":"Nutrition Supplements and Serum Albumin in Hemodialysis: A Meta-Analysis.","authors":"Avigal Adar, Vered Kaufman-Shriqui, Mona Boaz","doi":"10.37765/ajmc.2026.89998","DOIUrl":"10.37765/ajmc.2026.89998","url":null,"abstract":"<p><strong>Objective: </strong>The present meta-analysis was designed to examine the effect of oral nutrition supplements (ONS) and/or intradialytic parenteral nutrition (IDPN) therapy on serum albumin, a marker of malnutrition risk in adults on hemodialysis (HD).</p><p><strong>Study design: </strong>Meta-analysis.</p><p><strong>Methods: </strong>The EMBASE, PubMed, Google Scholar, Cochrane Collaboration, ClinicalTrials.gov, and Australia New Zealand Clinical Trials Registry databases were queried using the search terms malnutrition , albumin , hemodialysis , oral nutrition supplement , and intradialytic parenteral nutrition . Studies published or registered from 2019 to 2024 were reviewed and scored by 2 investigators using the Critical Appraisal Skills Programme checklist. Only studies with a mean score of 9 or greater (70% of the total possible score) were included. Data were analyzed using MedCalc software 20.210. The Q and I 2 tests were calculated; a forest plot was generated, and the pooled standardized mean differences (SMDs) with 95% CIs were calculated using a random-effects model.</p><p><strong>Results: </strong>Of the originally identified 137 studies, 8 randomized clinical trials were included, involving 382 adult HD patients. The SMD in serum albumin between the active treatment group (ONS or IDPN) and the control group in the random-effects model was 0.372 g/dL (95% CI, 0.103-0.641; P = .007). Findings were robust in the fixed-effects model. Publication bias was not detected.</p><p><strong>Conclusion: </strong>ONS/IDPN significantly improved serum albumin in this random-effects meta-analysis model, and findings were consistent in the fixed-effects model. It can be concluded that ONS/IDPN improves serum albumin levels, which can serve as a marker of malnutrition risk in patients on maintenance HD.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"32 8","pages":"e293-e299"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medicare Accountable Care Organizations: Clinical Performance for Patients With Heart Failure.","authors":"Christine DeJong, Thomas D'Aunno, Briana Jurkowski, Yolanda Wiggins, Peter K Lindenauer, Erica S Spatz, Rachel M Werner, Tara Lagu","doi":"10.37765/ajmc.2026.89997","DOIUrl":"https://doi.org/10.37765/ajmc.2026.89997","url":null,"abstract":"<p><strong>Objectives: </strong>Objective: To understand factors that distinguish higher-performing accountable care organizations (ACOs) in the Medicare Shared Savings Program from those with average levels of clinical performance for patients with heart failure (HF), a common and complex condition.</p><p><strong>Study design: </strong>We used a 2-step design. First, we measured ACOs' clinical performance using Medicare data to calculate risk-standardized admission rates over time (2014-2017) for patients with HF. Next, we conducted 16 videoconference interviews with key informants in 2 ACOs that were average performers on this measure and 2 that were higher performers. At each ACO, we interviewed at least 1 of 4 key informant types: top leader, manager or director, clinical-level staff, and HF clinician or cardiologist.</p><p><strong>Methods: </strong>We developed semistructured interview guides that included questions about ACO history and geographic context, organization and governance, management and leadership, and care management practices.</p><p><strong>Results: </strong>A combination of factors distinguishes higher-performing ACOs from average performers: fewer ACO staff and offices, majority-White beneficiary populations, and primary care physician leaders. In addition, higher-performing ACOs were characterized by close communication, real-time information sharing, regular feedback, physician buy-in, and strong care management programs.</p><p><strong>Conclusions: </strong>The results suggest a challenge in scaling up the best practices of small, primary care-centered ACOs to improve the performance of larger, complex hospital-dominated health systems. The results also suggest prioritizing the development of data and information systems that track patients in real time and provide clinicians with regular feedback on the quality of their work.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"32 8","pages":"e286-e292"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cancer mRNA Vaccines: Separating Scientific Progress From Political Debate.","authors":"Sucharu Chris Prakash","doi":"10.37765/ajmc.2026.90035","DOIUrl":"https://doi.org/10.37765/ajmc.2026.90035","url":null,"abstract":"","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"32 Spec. No. 9","pages":"SP445"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Promise and Politics of Creating mRNA Vaccines in Cancer.","authors":"Ryan Flinn","doi":"10.37765/ajmc.2026.90036","DOIUrl":"https://doi.org/10.37765/ajmc.2026.90036","url":null,"abstract":"","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"32 Spec. No. 9","pages":"SP446-SP448"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Evolving Oversight of For-Profit Health Care: The Massachusetts Initiative.","authors":"Eli Y Adashi, I Glenn Cohen","doi":"10.37765/ajmc.2026.89994","DOIUrl":"https://doi.org/10.37765/ajmc.2026.89994","url":null,"abstract":"","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"32 8","pages":"e263-e264"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social Risk-Weighted Scoring to Improve Medicare Advantage Star Ratings.","authors":"Andrew Anderson, Rajesh Satpathy-Horton, Denis Agniel","doi":"10.37765/ajmc.2026.90001","DOIUrl":"https://doi.org/10.37765/ajmc.2026.90001","url":null,"abstract":"<p><strong>Objectives: </strong>Medicare Advantage (MA) Star Ratings influence bonus payments and health plan enrollment. Current approaches to accounting for enrollee social risk may not fully capture differences in beneficiary populations. This study assessed how MA contract performance rankings for statin receipt and adherence change under a social risk-weighted scoring approach.</p><p><strong>Study design: </strong>Cross-sectional analysis of 2019 MA encounter, prescription drug, and enrollment data for 165 MA contracts.</p><p><strong>Methods: </strong>Contract-level statin receipt and adherence scores were calculated for disability and dual-eligibility subgroups and aggregated using empirically derived weights from a constrained optimization framework that equalized each subgroup's contribution to overall contract performance. Ordered logistic regression assessed associations between contract characteristics and weighted performance.</p><p><strong>Results: </strong>Social risk-weighted scoring reclassified 24.2% of contracts for statin receipt and 20.6% for adherence relative to unweighted scoring. For statin receipt, 11.5% of contracts moved up, 12.7% moved down, and 75.8% were unchanged; for adherence, 7.3% moved up, 13.3% moved down, and 79.4% were unchanged. Under the weighted approach, higher disability prevalence remained associated with lower performance ratings even after weighting: Each 1-percentage point (PP) increase in disability prevalence corresponded to a 0.7-PP higher probability of receiving 3 or fewer stars for statin receipt and a 1.3-PP higher probability for adherence. Larger contracts also had lower predicted probabilities of receiving 4 stars, decreasing by 3.4 PPs for receipt and 3.8 PPs for adherence per 1-unit increase in log enrollment.</p><p><strong>Conclusions: </strong>Social risk weighting rebalanced contract rankings but did not consistently improve ratings for high-risk plans. Remaining variation may reflect differences in quality or unmeasured factors.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"32 8","pages":"456-462"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insurance-Provided Grocery Assistance and Health Care Outcomes Among Patients With Diabetes.","authors":"Jeff Romine, Winnie Chi, Kofi Essel, Renee Mullikin, Donna Gibson, Shantanu Agrawal","doi":"10.37765/ajmc.2026.89932","DOIUrl":"10.37765/ajmc.2026.89932","url":null,"abstract":"<p><strong>Objective: </strong>To examine the association between a health insurance plan offering a grocery assistance benefit to members with diabetes and their health care use and outcomes.</p><p><strong>Study design: </strong>This retrospective, observational study used administrative claims to examine the associations of receiving grocery assistance provided by a health plan and health care use among patients with diabetes. A new health plan with low premiums and a grocery benefit (the intervention) was offered to a select group of members in 2021 and 2022. The intervention group examined in this study was made up of members with diabetes who selected the new health plan with the grocery benefit; the control group consisted of members with diabetes who were eligible for but chose not to select the new health plan with the grocery benefit.</p><p><strong>Methods: </strong>We used a doubly robust inverse probability weighted difference-in-differences design to analyze the impact on health care use, including inpatient and outpatient utilization and medication adherence, and on health outcomes, including those related to diabetes complications.</p><p><strong>Results: </strong>The intervention group saw an associated decrease of 3.1 percentage points in the prevalence of diabetes with complications. We also found significant associated increases in adherence to diabetes medications. No significant associated changes in health care service utilization or other health outcomes were observed.</p><p><strong>Conclusions: </strong>Providing low-touch grocery assistance to members with diabetes improved management of diabetes complications. The findings suggest that integrating nutritional benefits into health plans may enhance health outcomes without increasing overall health care utilization. Further research is needed to explore the long-term impact and scalability of such interventions.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"32 8","pages":"e280-e285"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prior Authorization Requirements in Medicare Advantage and County Social Vulnerability.","authors":"Eunhae Shin, Lianlian Lei","doi":"10.37765/ajmc.2026.90000","DOIUrl":"10.37765/ajmc.2026.90000","url":null,"abstract":"<p><strong>Objective: </strong>To assess whether Medicare Advantage (MA) beneficiaries in socially vulnerable counties face more restrictive prior authorization (PA) requirements.</p><p><strong>Study design: </strong>Cross-sectional analysis of 2945 US counties in 2022.</p><p><strong>Methods: </strong>The primary outcome was the mean percentage of Medicare-covered service categories requiring PA across all MA plans in a county, adjusted for service mix and plan enrollment and derived from the CMS MA benefit, landscape, and enrollment files. Secondary outcomes included county-level PA rates for selected service categories, the number of plans with more vs less restrictive PA policies, and mean monthly premiums. The exposure was the county-level Social Vulnerability Index (SVI) subdomains (socioeconomic status, household characteristics, racial/ethnic minority status, housing and transportation), categorized into deciles. Unadjusted linear regression models were used, weighted by county MA enrollment.</p><p><strong>Results: </strong>Counties in the highest vs lowest SVI decile in the socioeconomic domain had overall PA rates that were 7.2 percentage points (PP) higher ( P  < .001), with the largest gap for psychiatric services (16.9 PP; P  < .001). Conversely, mean monthly premiums declined across socioeconomic deciles, from $29 in the first decile to $8 in the 10th ( P  < .001). Total plan counts were stable across deciles, but the composition differed: The most vulnerable counties offered 5 fewer plans with less restrictive PA policies and 4 more plans with more restrictive policies (both P  < .001).</p><p><strong>Conclusions: </strong>MA beneficiaries in socially vulnerable counties face more restrictive PA requirements, especially for psychiatric services. These disparities may compound existing structural barriers and warrant consideration in future MA policy reforms.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"32 8","pages":"444-451"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remote Monitoring and Self-Efficacy: Implications for Breast Cancer Survivorship Outcomes.","authors":"Ilana Graetz, Samuel Hernandez, Xin Hu, Rebecca A Krukowski, Gregory A Vidal, Lee S Schwartzberg","doi":"10.37765/ajmc.2026.89999","DOIUrl":"10.37765/ajmc.2026.89999","url":null,"abstract":"<p><strong>Objectives: </strong>To examine whether self-efficacy in managing symptoms is associated with symptom burden and adjuvant endocrine therapy (AET) adherence among women with early-stage breast cancer and whether self-efficacy modifies the effects of a remote monitoring intervention.</p><p><strong>Study design: </strong>Post hoc analysis of a randomized trial evaluating app-based remote monitoring of self-reported symptoms and adherence for women prescribed AET.</p><p><strong>Methods: </strong>Participants were randomly assigned to enhanced usual care (EUC), app only (weekly remote monitoring), or app plus feedback (with weekly tailored supportive text messages). Outcomes included 12-month symptom burden (Functional Assessment of Cancer Therapy-Endocrine Subscale [FACT-ES]) and adherence (≥ 80% of expected doses recorded using a connected pillbox). Multivariable regression evaluated associations of the PROMIS (Patient-Reported Outcomes Measurement Information System) Self-Efficacy for Managing Symptoms T score with symptom burden and adherence as well as differential intervention effects by self-efficacy level.</p><p><strong>Results: </strong>Among 264 participants (mean age, 58.5 years; 64% White, 32% Black), mean (SD) baseline self-efficacy exceeded the normative mean of 50 (54.2 [9.9]). Higher self-efficacy was associated with lower symptom burden (eg, higher FACT-ES score: 0.6; 95% CI, 0.3-0.8) and greater odds of adherence (OR, 1.1; 95% CI, 1.0-1.1). Adherence benefits were greater at lower self-efficacy levels (eg, at a score of 30, 52.7% were adherent in app + feedback vs 17.8% in EUC; +34.9 percentage points; 95% CI, 1.0-68.9; P  = .04), with effects diminishing and becoming nonsignificant at higher self-efficacy levels.</p><p><strong>Conclusions: </strong>Without additional support, breast cancer survivors with low self-efficacy had poorer symptom control and lower adherence. Remote symptom monitoring with tailored messaging was most effective among women with lower self-efficacy levels, highlighting the need for screening and targeted interventions for patients most likely to benefit.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"32 8","pages":"437-443"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nationwide Trends and Cost Implications of Switching Between Infliximab Products.","authors":"Samantha R Paglinco, Mahmoud Abdel-Rasoul, Megan McNicol, Ross M Maltz","doi":"10.37765/ajmc.2026.89995","DOIUrl":"https://doi.org/10.37765/ajmc.2026.89995","url":null,"abstract":"<p><strong>Objectives: </strong>The introduction of infliximab biosimilars in the US has helped curb health care costs through competitive pricing. Many insurance payers have mandated switches from the originator to an infliximab biosimilar citing cost savings. This study assessed the cost savings to insurance payers and patients associated with switching infliximab products using a commercial claims database.</p><p><strong>Study design: </strong>This is a retrospective cohort study of commercially insured patients who received multiple infliximab products between 2015 and 2021 using administrative claims data.</p><p><strong>Methods: </strong>Infliximab outpatient claims from 2015 to 2021 were reviewed using the Merative MarketScan Commercial Claims and Encounters Database. Patients who switched infliximab products were identified by changes in Current Procedural Terminology codes. Cost savings to insurance payers and patients were calculated with infliximab product switches.</p><p><strong>Results: </strong>A total of 1785 patients underwent at least 1 infliximab product switch, with the majority occurring in 2021. Of the first-time switches, 92% (n = 1642) were from the infliximab originator to a biosimilar, with 72% (n = 1286) switching to infliximab-dyyb (Inflectra; Celltrion, Inc). Thirteen percent (n = 232) underwent 2 or more switches. Insurance payers saw a peak savings from product switching in 2019, with a median (IQR) of $1088 ($612-$1888) saved per infusion. Savings decreased to $61 (-$321 to $639) per infusion in 2021. Median patient out-of-pocket savings remained $0 throughout the study.</p><p><strong>Conclusions: </strong>Switching to infliximab biosimilars increased over the study period. Cost savings for insurers peaked in 2019 but were negligible by 2021. Patients did not experience any savings from switching. Because nonmedical switching burdens providers and risks patient harm without clear economic benefits, mandatory switches demand greater system transparency to prioritize patient welfare.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"32 8","pages":"e265-e272"},"PeriodicalIF":2.1,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}