{"title":"Racial/ethnic differences in colorectal cancer screening in the US.","authors":"Yize Richard Wang","doi":"10.37765/ajmc.2025.89779","DOIUrl":"10.37765/ajmc.2025.89779","url":null,"abstract":"<p><strong>Objectives: </strong>There are well-known racial/ethnic differences in colorectal cancer (CRC) screening in the US. This study aimed to assess whether racial/ethnic differences in CRC screening persisted in 2021 and how demographic and socioeconomic factors contributed to these differences.</p><p><strong>Study design: </strong>Population-based study.</p><p><strong>Methods: </strong>All adults aged 50 to 75 years in the 2021 National Health Interview Survey were included. The rate of CRC screening was calculated for non-Hispanic White, Black/African American, Hispanic, and Asian individuals. Multivariate logistic regression was used to examine racial/ethnic differences in CRC screening, controlling for age, sex, immigrant status (vs born in the US), college education (vs no college education), and insured status (vs uninsured status).</p><p><strong>Results: </strong>The rate of CRC screening was highest in the non-Hispanic White group (74.4%), followed by the Black/African American (70.9%), Hispanic (61.7%), and Asian (59.5%) groups (P < .01). In multivariate logistic regression, there was no significant racial/ethnic difference in CRC screening after controlling for age (OR, 1.07; 95% CI, 1.06-1.08), female sex (OR, 1.08; 95% CI, 0.997-1.18), immigrant status (OR, 0.62; 95% CI, 0.54-0.70), college education (OR, 1.65; 95% CI, 1.52-1.80), and insured status (OR, 4.38; 95% CI, 3.67-5.23). Sensitivity analysis on colonoscopy use confirmed these findings, except for less colonoscopy use in Asian individuals (OR, 0.73; 95% CI, 0.60-0.89).</p><p><strong>Conclusions: </strong>Racial/ethnic differences in CRC screening in the US were due to differences in demographic and socioeconomic factors, except for persistently low colonoscopy use in Asian individuals.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 8","pages":"e235-e237"},"PeriodicalIF":2.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884248","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}
Shirley Cohen-Mekelburg, Jeffrey Gibbs, Beth Wallace, Brooke Kenney, Akbar K Waljee
{"title":"Corticosteroid premedication for infliximab remains unnecessarily common.","authors":"Shirley Cohen-Mekelburg, Jeffrey Gibbs, Beth Wallace, Brooke Kenney, Akbar K Waljee","doi":"10.37765/ajmc.2025.89765","DOIUrl":"https://doi.org/10.37765/ajmc.2025.89765","url":null,"abstract":"<p><strong>Objectives: </strong>Corticosteroid use can lead to serious adverse events even with short-term use. Data suggest that corticosteroid premedication prior to infliximab (IFX) administration is ineffective at preventing infusion reactions. Therefore, we examined corticosteroid premedication practices in inflammatory bowel disease (IBD), which represent an opportunity for reducing corticosteroid overuse.</p><p><strong>Study design: </strong>National cohort study of patients with IBD receiving IFX using 2015-2021 Truven (now Merative) MarketScan data.</p><p><strong>Methods: </strong>We examined corticosteroid premedication as an outcome of interest using descriptive statistics and identified associated patient-level factors using bivariate analyses. We also explored differences in corticosteroid premedication for first IFX infusions (ie, no opportunity for a prior reaction) and subsequent IFX infusions.</p><p><strong>Results: </strong>We identified 19,637 patients with IBD who received IFX and met the inclusion criteria. Corticosteroid premedication use declined from 27.4% in 2015 to 20.4% in 2020. During this time, 38.7% of the 4639 patients who received IFX premedication were premedicated for more than 90% of their infusions. Overall, those who received corticosteroid premedication were younger (median age, 30 vs 33 years), more often female (51.6% vs 47.7%), and more likely to have 1 or more comorbidities (21.7% vs 18.8%) than patients who were not premedicated, but the groups had similar rates of diabetes (4.1% vs 4.2%), cataracts (1.4% vs 1.3%), and osteoporosis (1.4% for both). Among patients receiving corticosteroid premedication, 62.5% received it with their first IFX infusion, suggesting routine practice rather than a strategy for those who had a prior infusion reaction.</p><p><strong>Conclusions: </strong>Corticosteroid premedication for IFX remains unnecessarily common. Corticosteroid premedicating is a common low-value practice that could be targeted to reduce corticosteroid overuse in IBD.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 7","pages":"323-327"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709734","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}
Melanie D Whittington, Louis P Garrison, Jonathan D Campbell
{"title":"Challenges with judging and interpreting a drug's launch price.","authors":"Melanie D Whittington, Louis P Garrison, Jonathan D Campbell","doi":"10.37765/ajmc.2025.89715","DOIUrl":"https://doi.org/10.37765/ajmc.2025.89715","url":null,"abstract":"<p><p>This commentary explains why comparing a launch price with a value-based price from a cost-effectiveness analysis requires further examination.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 7","pages":"317-319"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709761","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}
Nadia Nabulsi, François Laliberté, Enrico Zanardo, Sean D MacKnight, Sophie Ma, Sally W Wade, Mousam Parikh
{"title":"Effects of adjunctive cariprazine formulary restrictions in major depressive disorder.","authors":"Nadia Nabulsi, François Laliberté, Enrico Zanardo, Sean D MacKnight, Sophie Ma, Sally W Wade, Mousam Parikh","doi":"10.37765/ajmc.2025.89770","DOIUrl":"https://doi.org/10.37765/ajmc.2025.89770","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the effects of formulary-related rejections of initial adjunctive cariprazine (Vraylar) claims on health care resource utilization (HCRU) among patients with major depressive disorder (MDD).</p><p><strong>Study design: </strong>Retrospective claims-based analysis.</p><p><strong>Methods: </strong>Using data from Symphony Health Integrated Dataverse from March 2015 through October 2020, we identified adults with MDD who were being treated with antidepressants and had an initial cariprazine claim that was either rejected for a formulary-related reason (eg, noncoverage, prior authorization requirement, step therapy requirement) or approved; rejected patients were required to receive a subsequent atypical antipsychotic (which helps balance the health status across cohorts but may induce bias and affect generalizability). Rejected and approved cohorts were matched (1:2) using propensity scores. Outcomes included all-cause and mental health (MH)-related HCRU (hospitalizations, emergency department [ED] visits, outpatient visits) and treatment patterns. HCRU was compared between cohorts using rate ratios (RRs), with 95% CIs and P values. Treatment patterns were analyzed using descriptive statistics.</p><p><strong>Results: </strong>The rejected cohort comprised 566 patients, with 1132 matched patients in the approved cohort. All-cause and MH-related hospitalization rates were 61% and 89% higher, respectively, for the rejected vs approved cohort (all-cause: RR, 1.61; 95% CI, 1.15-2.32; P = .012; MH related: RR, 1.89; 95% CI, 1.18-2.89; P = .016). ED and outpatient visit rates were similar. Patients in the rejected cohort often never received cariprazine (68.4%), and those who did received it after a 6-month delay on average.</p><p><strong>Conclusions: </strong>Patients with MDD who had an initial adjunctive cariprazine claim rejected for a formulary-related reason and subsequently received an atypical antipsychotic experienced significantly higher hospitalization rates than those with approved initial cariprazine claims, suggesting that formulary restrictions on adjunctive cariprazine may be associated with negative downstream effects.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 7","pages":"e191-e200"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709735","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":"Assertive community treatment for complex and costly patients.","authors":"Trygve Dolber, Patrick Runnels, Peter J Pronovost","doi":"10.37765/ajmc.2025.89768","DOIUrl":"https://doi.org/10.37765/ajmc.2025.89768","url":null,"abstract":"<p><p>Assertive community treatment, a strongly evidence-based practice for delivering care to individuals with schizophrenia and low health care engagement, is applicable to disengaged, medically complex patients.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 7","pages":"e173-e175"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709760","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}
Justin G Trogdon, Kathryn R Brignole, Ben Fogel, Tara Licciardello Queen
{"title":"Prevalence and inclusiveness of pay-for-performance incentives for HPV vaccination.","authors":"Justin G Trogdon, Kathryn R Brignole, Ben Fogel, Tara Licciardello Queen","doi":"10.37765/ajmc.2025.89769","DOIUrl":"10.37765/ajmc.2025.89769","url":null,"abstract":"<p><strong>Objectives: </strong>We examine the prevalence of pay-for-performance (P4P) incentives to promote human papillomavirus (HPV) vaccination and eligibility for P4P incentives as reported by clinical staff.</p><p><strong>Study design: </strong>A 2022 survey of primary care clinical staff in the US who provided HPV vaccination to children aged 9 to 12 years (N = 2527; response rate, 57%).</p><p><strong>Methods: </strong>The primary outcome was a mutually exclusive categorical variable for the type of P4P quality metrics used in the past year: HPV vaccination, other pediatric vaccinations, other quality metrics, or none. The secondary outcome was an indicator variable for whether the respondent was, or would be, eligible for P4P incentives. We adjusted logistic models for clinical staff and clinic characteristics.</p><p><strong>Results: </strong>Only 8% (n = 193) of respondents reported use of P4P incentives for HPV vaccination in their clinic. Clinics that were part of a health care system were more likely to have used P4P incentives for HPV vaccination (relative risk ratio [RRR] for respondents in systems of ≥ 5 clinics vs respondents not in systems, 2.06; 95% CI, 1.38-3.08), and clinics that saw more children were more likely to have used P4P incentives for HPV vaccination (RRR for respondents in clinics seeing ≥ 50 children vs clinics seeing 0-9 children per week, 2.64; 95% CI, 1.44-4.82). Physicians were more than twice as likely as other clinical staff to be eligible for P4P incentives (eg: OR for physician assistant, 0.40; 95% CI, 0.28-0.59).</p><p><strong>Conclusions: </strong>Opportunities exist to extend P4P incentives in primary care to promote HPV vaccination.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 7","pages":"e183-e190"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12376772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709739","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":"Managed care reflections: a Q&A with David J. Shulkin, MD.","authors":"David J Shulkin, Christina Mattina","doi":"10.37765/ajmc.2025.89764","DOIUrl":"10.37765/ajmc.2025.89764","url":null,"abstract":"<p><p>To 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 July issue features a conversation with David J. Shulkin, MD, a physician and former secretary of the US Department of Veterans Affairs.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 7","pages":"314-315"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709737","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}
Ubong Silas, Juliane Hafermann, Antonia Bosworth Smith, Alex Veloz, Rhodri Saunders, D Eric Steidley
{"title":"Clinical outcomes in heart failure monitoring: a pooled rates analysis.","authors":"Ubong Silas, Juliane Hafermann, Antonia Bosworth Smith, Alex Veloz, Rhodri Saunders, D Eric Steidley","doi":"10.37765/ajmc.2025.89702","DOIUrl":"https://doi.org/10.37765/ajmc.2025.89702","url":null,"abstract":"<p><strong>Objective: </strong>To understand clinical and health economic outcomes in patients receiving standard-of-care (SOC), out-of-hospital management for recently diagnosed heart failure (HF) in the US.</p><p><strong>Study design: </strong>Systematic literature review with a subsequent pooled rates analysis.</p><p><strong>Methods: </strong>Researchers reviewed randomized controlled trials (RCTs) indexed in PubMed and EMBASE between 2008 and 2023. RCTs were selected as the data sources because of the standardized reporting on outcomes and prospective data. Studies included in the analysis reported on US patients recently diagnosed with HF who underwent watchful waiting after discharge. The study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, with details reported in the PROSPERO study protocol (No. CRD42023410084). The pooled estimates of all-cause and HF-specific hospital readmissions, length of hospital stay, emergency department visits, and mortality at 3, 6, and 12 months were calculated using R software's meta and metafor packages.</p><p><strong>Results: </strong>There were 31 studies that met the inclusion criteria and reported data for 6916 patients with HF receiving SOC. The proportions of patients with a readmission and an emergency department visit at 3 months were 32.55% (95% CI, 24.03%-41.63%) and 13.83% (95% CI, 8.21%-20.49%), respectively. Mortality over the same period was 3.46%. Quality-of-life and cost data were heterogeneous and infrequently reported, preventing pooled analyses of these data. Length of stay had a pooled value of 7.12 days (95% CI, 5.78-8.46).</p><p><strong>Conclusion: </strong>HF with SOC monitoring is associated with substantial health care burden. Improvements in SOC monitoring, potentially through remote monitoring and management, could be beneficial to patients, clinicians, and payers.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 7","pages":"e201-e211"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709733","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}
Kathryn Corelli, Erin Duralde, Diya Mathur, Mary Price, Nicole M Benson, Nishmi Abeyweera, Vicki Fung, Christine Vogeli, Katherine H Schiavoni, Maryann M Vienneau, Mallika L Mendu, Lindsay Jubelt, Gregg S Meyer, John Hsu
{"title":"High-risk care management impact on Medicaid ACO utilization and spending.","authors":"Kathryn Corelli, Erin Duralde, Diya Mathur, Mary Price, Nicole M Benson, Nishmi Abeyweera, Vicki Fung, Christine Vogeli, Katherine H Schiavoni, Maryann M Vienneau, Mallika L Mendu, Lindsay Jubelt, Gregg S Meyer, John Hsu","doi":"10.37765/ajmc.2025.89766","DOIUrl":"https://doi.org/10.37765/ajmc.2025.89766","url":null,"abstract":"<p><strong>Objectives: </strong>States are experimenting with accountable care organization (ACO) contracts to slow Medicaid spending growth. There is limited information on how ACOs have impacted expenditures in Medicaid, which includes a relatively heterogenous population with less spending compared with Medicare. This study aimed to evaluate the impact of high-risk care management on spending and utilization within Massachusetts' largest Medicaid ACO.</p><p><strong>Study design: </strong>This observational study analyzed Medicaid claims data from Massachusetts' largest Medicaid ACO utilizing staggered program entry from 2016 to 2021 (n = 158,441 total beneficiaries). It included adults aged 18 to 64 years with multiple chronic conditions and used a claims-based algorithm for participant selection. We examined spending and clinical event rates of those participating and not yet participating in a high-risk care management program. Between 2016 and 2021, 2479 beneficiaries were identified as high risk and entered the program.</p><p><strong>Methods: </strong>The study utilized a difference-in-differences approach with linear regression models to assess the impact of care management. The analysis accounted for time-stable and time-changing covariates, including comorbidity levels and age.</p><p><strong>Results: </strong>Participation in the program for 7 or more months was associated with a $243 reduction in monthly spending compared with similar beneficiaries who had not yet started the program (95% CI, -$479 to -$6). There also were comparable reductions in emergency department visit and hospitalization rates.</p><p><strong>Conclusions: </strong>These early ACO data findings suggest that upstream care management of high-risk individuals may represent a viable approach for slowing Medicaid spending growth.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 7","pages":"334-339"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709736","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}
Tao Fan, Jeanne Jiang, Chiahung Chou, Henriette Coetzer, Kandavadivu Umashankar, Ninfa Candela, Jason Wagner
{"title":"Outcomes in patients with IBD stratified by risk of disease progression.","authors":"Tao Fan, Jeanne Jiang, Chiahung Chou, Henriette Coetzer, Kandavadivu Umashankar, Ninfa Candela, Jason Wagner","doi":"10.37765/ajmc.2025.89713","DOIUrl":"https://doi.org/10.37765/ajmc.2025.89713","url":null,"abstract":"<p><strong>Objectives: </strong>Risk stratification of patients with Crohn disease (CD) and ulcerative colitis (UC) may improve outcomes and health care resource utilization (HCRU). We characterized patients with CD or UC as being at high or low risk of disease progression and estimated rates of CD-related and UC-related HCRU.</p><p><strong>Study design: </strong>This retrospective study used claims data from a US health care payer database from January 1, 2017, to December 31, 2019.</p><p><strong>Methods: </strong>Included patients were fully insured, were 18 years or older, had a diagnosis of CD or UC, and were naive to biologic treatment. Patients were stratified as being at high or low risk of disease progression and associated HCRU using a priori definitions based on American Gastroenterological Association criteria.</p><p><strong>Results: </strong>For CD, 1459 (39.1%) patients were high risk and 2272 (60.9%) patients were low risk. High-risk patients had higher mean hospitalizations (0.35 vs 0.28; P = .03) and surgeries (0.04 vs 0.01; P < .0001) per patient than low-risk patients. During follow-up, 13.8% of patients with CD at high risk received advanced therapy vs 4.8% of low-risk patients. For UC, 2215 (40.4%) patients were high risk and 3270 (59.6%) patients were low risk. High-risk patients had higher mean hospitalizations (0.33 vs 0.10; P < .0001) and surgeries (0.01 vs 0.00; P < .0001) per patient than low-risk patients. During follow-up, 7.7% of patients with UC at high risk received advanced therapy vs 1.8% of low-risk patients.</p><p><strong>Conclusions: </strong>Health care claims data may be used for prognostic risk stratification in CD and UC and to identify patients who may benefit from early treatment with advanced therapies.</p>","PeriodicalId":50808,"journal":{"name":"American Journal of Managed Care","volume":"31 7","pages":"e176-e182"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709738","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}