American Journal of Managed Care最新文献

{"title":"Evaluating access to care for Medicare beneficiaries younger than 65 Years.","authors":"Emma M Achola, Shelley A Jazowski, Lauren Hersch Nicholas, Laura M Keohane, William A Wood, Christopher R Friese, Stacie B Dusetzina","doi":"10.37765/ajmc.2025.89732","DOIUrl":"10.37765/ajmc.2025.89732","url":null,"abstract":"<p><strong>Objectives: </strong>Individuals younger than 65 years can qualify for Medicare if they have long-term disabilities or certain qualifying conditions. These beneficiaries-particularly the non-dual-eligible population-may experience cost and access barriers to medical care. We examined the association between Medicare coverage type and reported barriers to care.</p><p><strong>Study design: </strong>Multivariable linear probability models assessed the association between self-reported Medicare coverage and patient-reported outcomes by dual-eligibility status.</p><p><strong>Methods: </strong>Using 2012-2020 data from the Health and Retirement Study, we compared self-reported sociodemographic and health-related characteristics of non-dual-eligible and dual-eligible beneficiaries aged 50 to 64 years by Medicare coverage type at their baseline interview. We then examined the following self-reported outcomes: experiencing cost-related medication nonadherence, delaying care due to cost, not having a usual source of care, and having trouble finding a doctor.</p><p><strong>Results: </strong>Among non-dual-eligible beneficiaries, enrollment in traditional Medicare (TM) plus supplemental coverage vs TM with no supplemental coverage was associated with lower reported rates of experiencing cost-related medication nonadherence (-7.5 percentage point [PP] change; 95% CI, -12.1 to -3.0), delaying care due to cost (-9.8 PP; 95% CI, -13.3 to -6.3), and having no usual source of care (-5.5 PP; 95% CI, -8.9 to -2.1). Compared with TM with no supplement, Medicare Advantage enrollment was associated with lower rates of delaying care due to cost (-4.2 PP; 95% CI, -7.6 to -0.7) and having no usual source of care (-5.2 PP; 95% CI, -8.2 to -2.3). Among dual-eligible beneficiaries, outcomes largely did not differ by coverage type. Switching from traditional Medicare to Medicare Advantage was associated with trouble finding a doctor for dual-eligible beneficiaries.</p><p><strong>Conclusions: </strong>Enrollment in less generous Medicare coverage was associated with greater cost and access barriers to care for beneficiaries younger than 65 years.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 5","pages":"222-229"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12231181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095717","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":"Quantifying the altruism value for a rare pediatric disease: Duchenne muscular dystrophy.","authors":"Jason Shafrin, Suhail Thahir, Alexa C Klimchak, Ivana Audhya, Lauren E Sedita, John A Romley","doi":"10.37765/ajmc.2025.89673","DOIUrl":"https://doi.org/10.37765/ajmc.2025.89673","url":null,"abstract":"<p><strong>Objectives: </strong>To quantify the magnitude of altruism value as applied to a hypothetical new treatment for a rare, severe pediatric disease: Duchenne muscular dystrophy (DMD).</p><p><strong>Study design: </strong>Prospective survey of individuals not planning to have children in the future.</p><p><strong>Methods: </strong>A survey was administered to US adults (aged ≥ 21 years) not intending to have a child in the future to elicit willingness to pay (WTP) for government insurance coverage for a new hypothetical DMD treatment that improves mortality and morbidity relative to the current standard of care. A multiple random staircase design was used to identify an indifference point between status quo government insurance coverage and coverage with additional cost in taxes that would cover the treatment if unrelated individuals had a child with DMD. Altruism value was calculated as respondents' mean WTP.</p><p><strong>Results: </strong>Among 215 respondents, 54.9% (n = 118) were aged 25 to 44 years and 80.0% (n = 172) were women. Mean WTP for insurance coverage of the hypothetical DMD treatment for others was $80.01 (95% CI, $41.64-$118.37) annually, or $6.67 monthly, after adjustment to account for disease probability overestimation. The adjusted altruism value was higher than the ex ante per-person value using traditional cost-effectiveness approaches ($45.30/year). Without adjusting, individuals were willing to pay $799.11 annually ($66.59 monthly).</p><p><strong>Conclusions: </strong>Despite no possibility of accruing health benefits directly for themselves or their children, individuals had a high WTP for government insurance coverage of a novel treatment for this rare, severe pediatric disease.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 5","pages":"240-244"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095776","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":"Digital health implementation among older adults: health technology navigators' perspectives.","authors":"Katarina Wang, Ann Marie Hernandez, Veronica Penate, Anshu Abhat, Alejandra Casillas","doi":"10.37765/ajmc.2025.89736","DOIUrl":"https://doi.org/10.37765/ajmc.2025.89736","url":null,"abstract":"<p><strong>Objectives: </strong>Despite the rise in health technology, a persistent digital divide affects underserved groups, including low-income, uninsured or underinsured, and limited English proficient (LEP) patients. This study highlights lessons learned from a unique stakeholder-health technology navigators-about factors affecting digital health use among older and linguistically diverse patients in one of the largest US safety-net health systems.</p><p><strong>Study design: </strong>We conducted in-depth interviews with Los Angeles County Department of Health Services (LAC DHS) navigators from June to December 2023. Discussions focused on their job role, identity, experiences supporting older patients (≥ 50 years) to register and use the patient portal, and linguistically diverse patients (primary language other than English or LEP) in this safety net.</p><p><strong>Methods: </strong>We used the Theoretical Domains Framework to create an interview guide. We interviewed 9 female and 2 male navigators across 9 LAC DHS clinics who were bilingual (English and Spanish). Interviews were transcribed and analyzed for major themes.</p><p><strong>Results: </strong>Three primary themes emerged from the qualitative analysis: characteristics of a successful navigator, patients' prior experiences with digital health, and barriers in the clinic.</p><p><strong>Conclusions: </strong>Navigators highlighted older patients' interest in learning to use digital tools and the need for support in digital health engagement. In describing their work with patients, navigators drew on their lived experiences with family and community to connect with these older patients in the Los Angeles safety-net health system. The lessons learned from these navigators can inform digital health engagement in other safety-net health settings so that they are more inclusive for older patients.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 5","pages":"e125-e131"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095729","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":"Managed care reflections: a Q&A with John Michael O'Brien, PharmD, MPH.","authors":"John Michael O'Brien, Christina Mattina","doi":"10.37765/ajmc.2025.89729","DOIUrl":"10.37765/ajmc.2025.89729","url":null,"abstract":"<p><p>To mark the 30th anniversary of The American Journal of Managed Care (AJMC), each issue in 2025 includes reflections from a thought leader on what has changed over the past 3 decades and what's next for managed care. The May issue features a conversation with John Michael O'Brien, PharmD, MPH, a member of AJMC's editorial board and the president and CEO of the National Pharmaceutical Council.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 5","pages":"209-211"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095773","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":"Predicting mortality risk using the PREVENT equation across diverse racial groups.","authors":"Ofer Kobo, Martin K Rutter, Shivani Misra, Erin D Michos, Phyo K Myint, Ariel Roguin, Louise Y Sun, Mamas A Mamas","doi":"10.37765/ajmc.2025.89734","DOIUrl":"10.37765/ajmc.2025.89734","url":null,"abstract":"<p><strong>Objectives: </strong>The Predicting Risk of CVD Events (PREVENT) score offers a contemporary tool for assessing cardiovascular risk without incorporating race, which has raised concerns about its performance across diverse racial and ethnic groups. We aimed to validate the performance of the PREVENT cardiovascular risk equation across diverse racial and ethnic groups and assess its association with long-term all-cause and cardiovascular mortality.</p><p><strong>Study design: </strong>Observational cohort study using nationally representative data from the National Health and Nutrition Examination Survey (NHANES) linked with mortality data.</p><p><strong>Methods: </strong>Using 10-year data from the NHANES (2009-2018), we analyzed a cohort of more than 177 million adults in the US to evaluate the association between baseline cardiovascular risk, as determined by the PREVENT overall cardiovascular disease risk equation, and long-term all-cause and cardiovascular mortality across racial and ethnic groups. The cohort was stratified by race and ethnicity. We employed Cox proportional hazards models to assess the relationship between cardiovascular risk and mortality.</p><p><strong>Results: </strong>Our analysis revealed significant variations in baseline cardiovascular risk across racial and ethnic groups. Across all groups, there was a consistent incremental increase in both cardiovascular and all-cause mortality rates with higher estimated cardiovascular risk. During up to a decade of follow-up, we found that individuals at high risk had a 6-fold higher risk of all-cause mortality and a 9-fold higher risk of cardiovascular mortality compared with individuals at low cardiovascular risk. The association between cardiovascular risk and mortality remained consistent across all racial and ethnic groups, albeit with very different risk estimates. For every 5% increase in estimated 10-year cardiovascular risk, there was a 54% increase in all-cause mortality and a 57% increase in cardiovascular mortality.</p><p><strong>Conclusions: </strong>These study findings validate PREVENT scores across diverse racial and ethnic populations, highlighting the tool's effectiveness in predicting cardiovascular risk and mortality regardless of race or ethnicity.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 5","pages":"e113-e119"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095774","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":"How employers can fight the price crisis.","authors":"Torie Nugent-Peterson, Ryan Olmstead","doi":"10.37765/ajmc.2025.89730","DOIUrl":"https://doi.org/10.37765/ajmc.2025.89730","url":null,"abstract":"<p><p>The US is in a health care price crisis that significantly impacts employees, employers, and public purchasers. With employer-sponsored health insurance covering 60% of Americans as of 2024, plan sponsors must consider policy advocacy as a part of their long-term cost containment strategy. Plan sponsors can leverage membership in national and regional health care business coalitions, such as The ERISA Industry Committee and the Employers' Forum of Indiana, for policy advocacy and education at federal and state levels. Coalition successes include Texas House Bill 711, which combats anticompetitive contracting practices, and Indiana's House Enrolled Act 1259, which enhances pricing transparency. Although navigating policy advocacy may seem daunting, Catalyst for Payment Reform emphasizes the importance of aligning public policy strategies with procurement/purchasing strategies. By engaging in tailored advocacy efforts, plan sponsors can help lower health care costs, improve access, and ensure sustainable benefits for their plan members.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 5","pages":"212-214"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095735","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":"Predictive models for low birth weight: a comparative analysis of algorithmic fairness-improving approaches.","authors":"Clare C Brown, Horacio Gomez-Acevedo, Benjamin C Amick, J Mick Tilford, Keneshia Bryant-Moore, Michael Thomsen","doi":"10.37765/ajmc.2025.89737","DOIUrl":"10.37765/ajmc.2025.89737","url":null,"abstract":"<p><strong>Objective: </strong>Evaluating whether common algorithmic fairness-improving approaches can improve low-birth-weight predictive model performance can provide important implications for population health management and health equity. This study aimed to evaluate alternative approaches for improving algorithmic fairness for low-birth-weight predictive models.</p><p><strong>Study design: </strong>Retrospective, cross-sectional study of birth certificates linked with medical insurance claims.</p><p><strong>Methods: </strong>Birth certificates (n = 191,943; 2014-2022) were linked with insurance claims (2013-2021) from the Arkansas All-Payer Claims Database to assess alternative approaches for algorithmic fairness in predictive models for low birth weight (< 2500 g). We fit an original model and compared 6 fairness-improving approaches using elastic net models trained and tested with 70/30 balanced random split samples and 10-fold cross validation.</p><p><strong>Results: </strong>The original model had lower accuracy (percent predicted correctly) in predicting low birth weight among Black, Native Hawaiian/Other Pacific Islander, Asian, and unknown racial/ethnic populations relative to White individuals. For Black individuals, accuracy increased with all 6 fairness-improving approaches relative to the original model; however, sensitivity (true-positives correctly predicted as low birth weight) significantly declined, as much as 31% (from 0.824 to 0.565), in 5 of 6 approaches.</p><p><strong>Conclusions: </strong>When developing and implementing decision-making algorithms, it is critical that model performance metrics align with management goals for the predictive tool. In our study, fairness-improving models improved accuracy and area under the curve scores for Black individuals but decreased sensitivity and negative predictive value, suggesting that the original model, although unfair, was not improved. Implementation of unfair models for allocating preventive services could perpetuate racial/ethnic inequities by failing to identify individuals most at risk for a low-birth-weight delivery.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 5","pages":"e132-e137"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12109546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095775","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":"Effects of Maryland's All-Payer Model on elective joint replacement surgery.","authors":"Meiling Ying, Addison Shay, John M Hollingsworth, Vahakn B Shahinian, Richard A Hirth, Brent K Hollenbeck","doi":"10.37765/ajmc.2025.89735","DOIUrl":"10.37765/ajmc.2025.89735","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the Maryland All-Payer Model's impact on the rate of elective major joint replacement surgery.</p><p><strong>Study design: </strong>A retrospective cohort study of patients in Maryland undergoing elective major joint replacement between 2011 and 2018 was performed using a 20% fee-for-service Medicare sample in a difference-in-difference framework with patients undergoing hip fracture repair serving as controls.</p><p><strong>Methods: </strong>Among Maryland residents, there were 7147 Medicare fee-for-service patients undergoing elective major joint replacement and 1008 Medicare fee-for-service beneficiaries undergoing hip fracture repair. We used patient-level generalized linear models with a negative binomial family function and a log link function to estimate the association of the All-Payer Model with the rate of elective major joint replacement surgery.</p><p><strong>Results: </strong>Under the All-Payer Model, the rate of elective major joint replacement surgery increased more than that of hip fracture repair (adjusted relative risk, 1.31; 95% CI, 1.15-1.51). Compared with hospitals without affiliates in adjacent states (Maryland-only hospitals), those with affiliates (Maryland hospitals with affiliates) saw rates of elective major joint replacement grow more slowly (adjusted relative risk, 0.87; 95% CI, 0.80-0.95) after the All-Payer Model. Furthermore, major joint replacement rates for Maryland residents at affiliated hospitals in adjacent states increased from 4.26 per 10,000 in the preintervention period to 5.23 per 10,000 in the postintervention period.</p><p><strong>Conclusions: </strong>Under the All-Payer Model, population-based rates of elective major joint replacement surgery increased more rapidly than did rates of hip fracture repair. Although rates of major joint replacement at Maryland hospitals with affiliates grew more slowly than for Maryland-only hospitals, rates among Maryland residents increased at the affiliates in adjacent states.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 5","pages":"e120-e124"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12092050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095715","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":"Organizational factors associated with variation in primary care providers in ACOs.","authors":"Mariétou H Ouayogodé, Xiaodan Liang, Sancia K Ferguson","doi":"10.37765/ajmc.2025.89723","DOIUrl":"https://doi.org/10.37765/ajmc.2025.89723","url":null,"abstract":"<p><strong>Objective: </strong> To assess the association between the organizational structure of accountable care organizations (ACOs) and provider workforce composition. Quantifying these relationships may improve understanding of factors contributing to changes in the health care workforce in ACOs and improve clinician recruitment and retention across ACOs to help them succeed in the program.</p><p><strong>Study design: </strong>Cross-sectional study of 409 ACOs from the National Survey of Accountable Care Organizations Wave 4 (2017-2018; response rate, 48%).</p><p><strong>Methods: </strong>We evaluated ACO provider workforce composition. In multivariable linear regression models, we examined the relationship among ACO provider workforce composition, contract type, structure, and financial risk level. For Medicare Shared Savings Program participants, we also assessed the role of the market environment.</p><p><strong>Results: </strong> We found that provider workforce composition varied across organizations by ACO contract payer. The percentage of primary care providers-physicians and nonphysician providers-was higher in smaller organizations with ACO contracts from a single public payer (77.7% for those with Medicaid-only contracts; 59.5% with Medicare-only contracts) relative to larger organizations with contracts from a single commercial payer (52.4% primary care providers) or multiple payers (54.8%-55.7%). A higher percentage of primary care providers in the ACO was associated with physician leadership, upside financial risk, and financial compensation of physicians being tied to performance measures.</p><p><strong>Conclusions: </strong>With payers' recent interest in more capitated payment models, larger ACOs should consider extending more population-based payments, provider engagement, and compensation strategies to engage aligned providers toward high quality and low costs, mitigate overall provider turnover, and make participation in ACOs sustainable.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 4","pages":"e87-e94"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057716","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 payer is associated with length of stay after traumatic brain injury.","authors":"John K Yue, Nishanth Krishnan, Christopher Toretsky, Renee Y Hsia, Geoffrey T Manley, W John Boscardin, Anil N Makam, Anthony M DiGiorgio","doi":"10.37765/ajmc.2025.89688","DOIUrl":"https://doi.org/10.37765/ajmc.2025.89688","url":null,"abstract":"<p><strong>Objectives: </strong>Timely provision of postacute care (PAC) rehabilitation is critical for achieving functional recovery after traumatic brain injury (TBI). Medicaid coverage is a predictor of prolonged hospital length of stay (LOS) after TBI, a proxy for decreased PAC access. Among Medicaid patients with TBI, it is unknown whether coverage under a managed care organization (MCO) or fee-for-service (FFS) model predicts differences in LOS.</p><p><strong>Study design: </strong>Discharge data for patients with TBI from 318 California hospitals between 2017 and 2019 were obtained. We used multivariable regression models, treating mortality/hospice disposition as competing risks, to evaluate associations between insurance type and LOS, adjusting for sociodemographic factors and illness severity. Sensitivity analysis was conducted in patients with severe TBI identified by receipt of intracranial pressure monitoring or trauma craniotomy/craniectomy. Adjusted HRs (aHRs) were reported.</p><p><strong>Methods: </strong>The California Department of Health Care Access and Information Patient Discharge Dataset was queried for patients with TBI using International Classification of Diseases, Tenth Revision, Clinical Modification codes. Exclusion criteria were younger than 18 years or older than 65 years, payer other than private insurance (PI) or Medicaid, death or hospice discharge within 5 days of hospitalization, presence of a do-not-resuscitate order, and nonemergency admission.</p><p><strong>Results: </strong>A total of 39,834 patients were analyzed (FFS, 24.2%; MCO, 33.2%; PI, 42.6%). Competing risk regressions showed that Medicaid models were associated with longer LOS compared with PI (FFS: aHR, 0.80; 95% CI, 0.80-0.83; MCO: aHR, 0.92; 95% CI, 0.87-0.96). Compared with MCOs, FFS was associated with longer LOS in the overall cohort (aHR, 0.88; 95% CI, 0.85-0.91) and in the severe TBI subgroup (aHR, 0.90; 95% CI, 0.82-0.99).</p><p><strong>Conclusions: </strong>Medicaid FFS is associated with increased LOS in hospitalized patients with TBI compared with Medicaid MCOs, suggesting decreased PAC access.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 4","pages":"173-181"},"PeriodicalIF":2.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055765","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}