JAMA Health Forum最新文献

{"title":"GLP-1 Receptor Agonist Coverage for Obesity in Medicaid and Total GLP-1 Receptor Agonist Utilization.","authors":"Ritikaa Khanna, Michael C Wang, Atheendar S Venkataramani","doi":"10.1001/jamahealthforum.2026.3353","DOIUrl":"10.1001/jamahealthforum.2026.3353","url":null,"abstract":"<p><strong>Importance: </strong>Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are effective for treating obesity, but few Medicaid programs cover them due to cost concerns with accelerating utilization. However, potential substitution effects between obesity-labeled GLP-1 RAs and diabetes-labeled GLP-1 RAs, which have identical active ingredients and which all states cover, are not well understood.</p><p><strong>Objective: </strong>To determine whether Medicaid coverage of obesity-labeled GLP-1 RAs is associated with obesity-labeled, diabetes-labeled, and total GLP-1 RA utilization.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study used US state-level Medicaid drug utilization data from 2021 to 2024. Synthetic difference-in-differences was used to assess the association of obesity-labeled GLP-1 RA coverage with GLP-1 RA utilization.</p><p><strong>Exposure: </strong>Medicaid program coverage of obesity-labeled GLP-1 RAs.</p><p><strong>Main outcomes and measures: </strong>The primary outcome was aggregate quarterly prescriptions per 1000 beneficiaries; secondary outcomes included prescription-months (accounting for duration of fills) and Medicaid reimbursement per 1000 beneficiaries.</p><p><strong>Results: </strong>Of 9 states (n = 89 021 657; mean [SD] of 49.4% [0.5%] were male, 50.6% [0.5%] were female) that began Medicaid coverage of obesity-labeled GLP-1 RAs between 2021 and 2024 and 36 control states (n = 212 786 953; mean [SD] of 49.8% [0.9%] were male, 50.2% [0.9%] were female), overall and diabetes-labeled GLP-1 RA utilization increased substantially in both groups, whereas obesity-labeled GLP-1 RA increased significantly only in treated states. Estimates from synthetic difference-in-differences models demonstrated a mean increase in obesity-labeled GLP-1 RA of 6.48 prescriptions per 1000 beneficiaries (95% CI, 4.00-8.96; P < .001), with estimates increasing nearly each quarter after Medicaid coverage was implemented. By contrast, changes in total GLP-1 RA prescriptions compared with obesity-labeled prescriptions were not statistically significant (4.17 per 1000 beneficiaries [95% CI, -0.33 to 8.67; P = .07]), nor were those for diabetes-labeled GLP-1 RA prescriptions (-2.16 prescriptions per 1000 beneficiaries [95% CI, -5.27 to 0.96; P = .17]). In the subgroup of states with prior authorization requirements more restrictive than the Food and Drug Administration label, there was a significant relative decrease in diabetes-labeled GLP-1 RA utilization of 3.02 prescriptions per 1000 beneficiaries (95% CI, -5.69 to -0.36; P = .03).</p><p><strong>Conclusions and relevance: </strong>Results of this study suggest that substitution effects are possible between obesity-labeled and diabetes-labeled GLP-1 RAs, varying by state coverage policies, that could impact coverage decisions.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 9","pages":"e263353"},"PeriodicalIF":12.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149065523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in Outpatient and Telehealth Visits Among Undocumented Patients.","authors":"Rahael Borchers, Francesco Sergi, Robert Rodriguez, Shaokui Ge, Elaine C Khoong, Melanie Molina","doi":"10.1001/jamahealthforum.2026.2749","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2026.2749","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Anti-immigration policies in 2025 may influence outpatient care and telehealth among immigrant communities. Understanding visit patterns is essential for health systems leaders to prepare for shifts in health care use and ensure preventive care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To compare outpatient in-person and telehealth visit completion rates among patients classified as likely undocumented and those likely with legal status, before and after 2025 federal immigration policy changes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cross-sectional study analyzed electronic health record data from outpatient encounters in a public safety-net system. Documentation status was approximated using non-English primary language without a Social Security number (SSN) to classify patients with likely undocumented status and using English primary language with SSN for patients likely with legal status. Analyses compared visits from January to June 2024 and January to June 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;Outcomes included the number of in-person visits, in-person visit completion (show) rate, and telehealth visit proportion as a percentage of total outpatient visits. Mixed Poisson regression was used to estimate incidence rate ratios (IRRs) for completed outpatient visits and telehealth visit counts by month, comparing both proxy groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;This study analyzed 184 541 outpatient visits in 2024 (48.7% females, 51% males, 0.2% other sex) and 182 573 outpatient visits in 2025 (49.8% females, 49.9% males, 0.3% other sex). During both 6-month periods, patients classified as likely undocumented had 15% higher in-person visit completion rates compared with patients likely with legal status (IRR, 1.15; 95% CI, 1.13-1.16). However, month-specific analyses found that in-person visit completion rates decreased in 2025 among likely undocumented patients, with decreases ranging from 5% to 12%, and significant decreases in March 2025 (IRR, 0.88; 95% CI, 0.83-0.93) and June 2025 (IRR, 0.93; 95% CI, 0.87-0.99) compared with 2024. The relative proportion of telehealth visits increased by 12% among likely undocumented patients between 2024 and 2025 (IRR, 1.12; 95% CI, 1.04-1.20) and decreased among patients likely with legal status (IRR, 0.95; 95% CI, 0.93-0.98). Among more than 367 000 visits, there was no clinically significant change in total visits for either group between 2024 and 2025 (IRR, 1.00; 95% CI, 0.99-1.02).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;This study found that patients classified as likely undocumented had higher in-person visit completion rates than patients likely with legal status, but experienced month-specific decreases, which may correspond to increased immigration enforcement activities. Their increased telehealth use underscores its importance as a critical access pathway. Health systems leaders should anticipate shifts in care use a","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 8","pages":"e262749"},"PeriodicalIF":12.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward Multiyear Enrollment in Medicare Advantage.","authors":"Dhruv Khullar, Sachin H Jain, Amelia M Bond","doi":"10.1001/jamahealthforum.2026.2399","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2026.2399","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 8","pages":"e262399"},"PeriodicalIF":12.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-Time Prescription Benefit Tool Availability and Prescription Medication Fill Rates: A Post Hoc Analysis of a Cluster Randomized Clinical Trial.","authors":"Roger Ying, Prianca Padmanabhan, Adam Szerencsy, Ateev Mehrotra, Leora I Horwitz, Sunita M Desai","doi":"10.1001/jamahealthforum.2026.2739","DOIUrl":"10.1001/jamahealthforum.2026.2739","url":null,"abstract":"<p><strong>Importance: </strong>Patients frequently forgo filling prescriptions due to high out-of-pocket costs. Real-time prescription benefit (RTPB) tools that recommend available lower-cost, clinically equivalent medications to prescribing clinicians may increase the likelihood that patients fill their prescriptions.</p><p><strong>Objective: </strong>To determine whether availability of an RTPB tool increases prescription fill rates.</p><p><strong>Design and setting: </strong>This post hoc analysis of a cluster randomized clinical trial included medical practices within an urban ambulatory clinical network randomized to the RTPB tool between January and December 2021. Outpatient prescriptions that were eligible for an RTPB recommendation during the study period were analyzed. Data analyses were performed from October 18, 2022, to August 9, 2024.</p><p><strong>Intervention: </strong>An electronic health record-integrated RTPB tool that displays available lower-cost and clinically equivalent alternatives to the initiated prescription at the point of prescribing.</p><p><strong>Main outcome and measure: </strong>The primary outcome measured whether a prescription was filled.</p><p><strong>Results: </strong>Of 1 386 577 outpatient prescriptions at randomized practices during the trial period, 38 289 (2.8%) were included in the analytic sample. Across all orders, the availability of the RTPB tool did not impact the proportion of orders filled (54% and 55% in the control and RTPB groups, respectively; adjusted difference: 1.2 percentage points [pp]; 95% CI, -1.3 to 3.7 pp). However, in the quartile of drug classes with the highest out-of-pocket costs (average out-of-pocket cost for a 30-day fill of >$120.83), fill rates increased from 33% in the control group to 49% in the RTPB group (adjusted difference: 14.5 pp; 95% CI, 8.4-20.6 pp). Similar increases were not detected in lower-cost drug classes. Increases in fill rates within the highest out-of-pocket cost drug classes were largest for patients in the lowest-income communities served by the health system (30.3 pp; 95% CI, 19.5-41.1 pp) but not substantial in the highest-income communities (1.0 pp; 95% CI, -10.2 to 12.2 pp).</p><p><strong>Conclusions and relevance: </strong>In this post hoc analysis of a cluster randomized clinical trial, there was no change in overall prescription fill rates, but among high-cost drugs, the RTPB tool increased fill rates, particularly among patients from low-income communities. However, RTPB recommendations were made for a small proportion of orders, limiting the applicability of the findings to a narrow segment of the randomized population.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT04940988.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 8","pages":"e262739"},"PeriodicalIF":12.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476843/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"JAMA Health Forum.","authors":"","doi":"10.1001/jamahealthforum.2025.6026","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.6026","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 8","pages":"e256026"},"PeriodicalIF":12.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mandatory Value-Based Payment Programs and Hospital Administrative Costs.","authors":"Zehui Zhou, Jason D Buxbaum, Andrew M Ryan","doi":"10.1001/jamahealthforum.2026.2503","DOIUrl":"10.1001/jamahealthforum.2026.2503","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Administrative costs account for nearly one-quarter of US hospital expenditures and are substantially higher than those in other high-income countries. Although mandatory value-based payment programs implemented by the Centers for Medicare & Medicaid Services (CMS) aim to improve quality and efficiency, they may be associated with increased administrative burden.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To evaluate the association between participation in CMS mandatory value-based payment programs and hospital administrative costs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This cohort study used a synthetic difference-in-differences design to compare hospital administrative costs obtained from the Medicare cost report data from fiscal years 2006 to 2020. The sample included Medicare-certified general acute care hospitals, critical access hospitals, and long-term acute care hospitals. Administrative costs at hospitals participating in mandatory value-based payment programs, including the Hospital Value-Based Purchasing (HVBP) program, Hospital Readmissions Reduction Program (HRRP), and Hospital-Acquired Condition Reduction Program (HACRP), were compared with hospitals not participating in these programs. In addition, hospitals participating in the Comprehensive Care for Joint Replacement (CJR) model were compared with hospitals not participating in this model. Data were analyzed between July 5 and December 25, 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Exposure: &lt;/strong&gt;Hospital participation in CMS mandatory value-based payment programs initiated under the Affordable Care Act (HVBP, HRRP, and HACRP) or the CJR model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcomes and measures: &lt;/strong&gt;The primary outcome was hospital administrative costs, defined as the sum of administrative and general, nursing administration, and medical records costs reported in Medicare cost report data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 4332 hospitals were included in the sample. Of these hospitals, 2820 (65.1%) participated in the mandatory value-based payment programs (HVBP, HRRP, and HACRP). Nonparticipating hospitals included 42 general acute care hospitals in Maryland (0.9%), 1159 critical access hospitals (26.8%), and 311 long-term acute care hospitals (7.2%). In addition, 357 hospitals participated in the CJR model compared with 2029 that did not participate in the model. Participation in the 3 mandatory value-based programs was associated with annual increases in administrative costs of $1.23 (95% CI, $0.11-$2.36) million per hospital compared with general acute care hospitals in Maryland, $0.93 (95% CI, $0.27-$1.59) million compared with critical access hospitals, and $0.65 (95% CI, $0.01-$1.29) million compared with long-term acute care hospitals. Participation in the CJR model was associated with an annual increase in administrative costs of $1.40 (95% CI, $0.30-$2.49) million per hospital. Aggregated nationally, these increases corresponded to more than","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 8","pages":"e262503"},"PeriodicalIF":12.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13451984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expansion of Medicaid Benefits for Medicare Beneficiaries in New York State.","authors":"Em Balkan, Laura M Keohane, Momotazur Rahman, Jaclyn M W Hughto, David J Meyers","doi":"10.1001/jamahealthforum.2026.2394","DOIUrl":"10.1001/jamahealthforum.2026.2394","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 8","pages":"e262394"},"PeriodicalIF":12.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13451982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refocusing Medicare Reform on Its Cost to Taxpayers.","authors":"Lanhee J Chen, Tom Church","doi":"10.1001/jamahealthforum.2026.3867","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2026.3867","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 8","pages":"e263867"},"PeriodicalIF":12.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maximum Out-of-Pocket Limits in Dual-Eligible Special Needs Plans.","authors":"Katherine M Ianni","doi":"10.1001/jamahealthforum.2026.2699","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2026.2699","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 8","pages":"e262699"},"PeriodicalIF":12.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13476844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Centering Corporate Activity in the Population Health Research Agenda.","authors":"Sandro Galea, Nason Maani","doi":"10.1001/jamahealthforum.2026.1007","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2026.1007","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 8","pages":"e261007"},"PeriodicalIF":12.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}