The American Journal of Managed Care

Assessing New York’s Health Care Disparities Using Health Plan Quality Data

Since implementing the Health Home program, New York has witnessed marked performance improvements for numerous HEDIS processes-of-care measures for Health Home enrollees and at least a 25% reduction ...

The Great GLP-1 Reset: Trump’s Medicare Deal Could Upend Telehealth’s Most Profitable Subscription

Trump’s GLP-1 price deal slashes costs and expands selective Medicare coverage—threatening telehealth startups and sparking a ...
Health Affairs

Coverage Denials: Government And Private Insurer Policies For Medical Necessity In Medicare

Little is publicly known about coverage denials for medical services that do not meet medical necessity criteria. We characterized the extent of these denials and their key features, using Medicare ...
Health Affairs

Frequency Of Indirect Billing To Medicare For Nurse Practitioner And Physician Assistant Office Visits

Nurse practitioners (NPs) and physician assistants (PAs) represent a growing share of the health care workforce, but much of the care they provide cannot be observed in claims data because of indirect ...