News
Contributor: Reimagining Beneficiary Engagement in Accountable Care Models to Make America Healthy Again | AJMC
8+ hour, 12+ min ago (493+ words) Contributor: Reimagining Beneficiary Engagement in Accountable Care Models to Make America Healthy Again'The American Journal of Managed Care" (AJMC") Accountable care organizations (ACOs) nurture strong patient-provider relationships to provide high-quality, coordinated health care focused on prevention and chronic condition management....
Increased Payments to Medicare Advantage Plans for Dually Eligible Beneficiaries | AJMC
5+ day, 4+ hour ago (574+ words) The American Journal of Managed Care Increasing Medicare Advantage payments for full Medicaid enrollees was not associated with meaningful changes in inpatient or nursing home use. Conclusions: These results raise questions about whether payment increases to MA plans led to…...
ACOs Improve Primary, Preventive Care Delivery for Medicare Beneficiaries | AJMC
5+ day, 13+ hour ago (341+ words) Beneficiaries in ACOs receive significantly higher rates of primary and preventive services, signaling value-based care's impact on quality and chronic disease management. Medicare beneficiaries whose physicians participate in accountable care organizations (ACOs), particularly those taking on financial risk for cost…...
Prior Authorization Ranked Top Barrier to Health Care Access After Cost | AJMC
1+ week, 14+ hour ago (463+ words) Prior authorization remains a major health care barrier, causing delays and frustrations for insured adults seeking necessary treatments. The poll was conducted January 13-20, 2026, among a nationally representative sample of 1426 US adults via online and telephone interviews in English and Spanish....
CMS Proposes Nearly Flat 2027 Medicare Advantage Payment Rates | AJMC
1+ week, 5+ day ago (409+ words) CMS's 2027 proposed MA payment rate increase of .09% falls short of expectations, potentially increasing premiums and reducing benefits for seniors. CMS released its 2027 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment…...
Catching Unethical Loopholes in ICD-10 Code Billing: Daniel Siegel, MD | AJMC
1+ week, 6+ day ago (616+ words) Catching Unethical Loopholes in ICD-10 Code Billing: Daniel Siegel, MD'The American Journal of Managed Care" (AJMC") It is important that dermatologists practice honest and ethical documentation and billing practices when applying the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10) code…...
Contributor: Network Integrity as a Strategic Lever—Aligning Ambulatory Operations with Managed Care Success | AJMC
2+ week, 19+ min ago (225+ words) Explore how network integrity enhances managed care strategies, driving value-based care success and improving patient outcomes in health systems. Network integrity refers to the extent to which patients receive care within a preferred, strategically aligned network of providers. It encompasses…...
Post-Pandemic Nursing Home Capacity Declines Tied to Longer Hospital Stays, Increased Patient Travel | AJMC
3+ week, 6+ day ago (615+ words) Nursing home capacity has declined since the COVID-19 pandemic, causing greater strain on postacute care, especially in rural areas. Skilled nursing facilities (SNFs), also known as nursing homes, experienced a decline in operating capacity following the COVID-19 pandemic, which was…...
Stuck in Prior Auth Purgatory: The Hidden Costs of Health Care Delays | AJMC
1+ mon, 2+ week ago (165+ words) Delays, denials, and endless paperwork'prior authorization isn't just a headache for providers; it's a barrier for patients who need timely care, explains Colin Banas, MD, MHA, chief medical officer with DrFirst. Today, we're diving into the frustrating world of prior…...
Managing Complex Medicare Patients in ACOs: Tom Kim, MD | AJMC
1+ mon, 3+ week ago (393+ words) Tom Kim, MD, of Sound Long-Term Care Management, discusses how serious illness and care coordination set these ACO patients apart. Medicare patients in accountable care organizations (ACOs) face ... Medicare patients in accountable care organizations (ACOs) face unique challenges, from advanced…...