The American journal of managed care
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Historical Article
Managed care reflections: a Q&A with Jan E. Berger, MD, MJ.
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 January issue features a conversation with longtime editorial board member Jan E. Berger, MD, MJ, the CEO of Health Intelligence Partners.
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Patients are often discharged to a skilled nursing facility (SNF) for postacute rehabilitation. Functional outcomes achieved in SNFs are variable, and costs are high. Especially for accountable care organizations (ACOs), home-based postacute rehabilitation offers a high-value option if outcomes are not compromised. The objective was to compare outcomes for episodes in a novel high-intensity home-based rehabilitation (HIHR) model vs an SNF. ⋯ The HIHR cohort demonstrated better functional outcomes and lower posthospital costs. HIHR may be a high-value option for patients attributed to a Medicare ACO who have moderate medical complexity and moderate functional deficits at the time of hospital discharge.
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Patients who revisit the emergency department (ED) shortly after discharge are a high-risk group for complications and death, and these revisits may have been seriously affected by the COVID-19 pandemic. Detecting suspected COVID-19 cases in EDs is resource intensive. We examined the associations of screening workload for suspected COVID-19 cases with in-hospital mortality and intensive care unit (ICU) admission during short-term ED revisits. ⋯ This is the first study to our knowledge to identify that screening for suspected COVID-19 cases in EDs can adversely affect patient outcomes during short ED revisits. Identifying this association could enable ED providers and policy makers to optimize emergency service delivery during an epidemic and help patients.
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Medicaid is the largest payer of mental health (MH) services in the US, and more than 80% of its enrollees are covered by Medicaid managed care (MMC). States are required to establish quantitative network adequacy standards (NAS) to regulate MMC plans' MH care access. We examined the association between quantitative NAS and MH care access among Medicaid-enrolled adults and among those with MH conditions. ⋯ Current quantitative NAS requirements may have few impacts on improving MH care access for adults and those with MH conditions without the implementation of additional interventions. States should consider adjusting enforcement strategies and adopting other interventions alongside NAS.