American Journal of Managed Care Editors Highlight Key Studies, Looking Back on 20 Years of Contributions

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The American Journal of Managed Care arrived in 1995, in the aftermath of the last major effort to remake the US healthcare system, and quickly became the most important forum of its type. Today, with the country implementing the Affordable Care Act, Editors-in-Chief A. Mark Fendrick, MD, and Michael Chernew, PhD, examine the impact of the journal’s contributions to healthcare delivery transformation.

The American Journal of Managed Care celebrates its 20th anniversary in 2015

One cannot overstate how important The American Journal of Managed Care has been to the ongoing conversation about healthcare delivery in the United States, said AJMC President Brian Haug.

Throughout 2015, The American Journal of Managed Care will celebrate 20 years as the leading forum for evidence-based research and commentary on healthcare delivery systems. In January, the look back begins as Editors-in-Chief A. Mark Fendrick, MD, and Michael Chernew, PhD, highlight key studies that have appeared since the journal’s inception.

Dr. Fendrick, professor in the Division of General Medicine, Department of Internal Medicine and Department of Health Management and Policy, is director at the University of Michigan Center for Value-Based Insurance Design. Dr. Chernew is the Leonard D. Schaeffer professor of Health Care Policy in the Department of Health Care Policy at Harvard Medical School.

Their commentary, “Celebrating Our 20th Anniversary,” acknowledges the vast changes that have occurred in healthcare delivery over two decades: “Managed care was still in its youth, global and bundled payment systems were rare, significant innovation in consumer engagement had not yet occurred, and ‘delivery system transformation’ was not the buzzword it is considered today,” they wrote.

The concept of “patient-centeredness” was unheard of, Drs. Fendrick and Chernew wrote. Much more common in the 1990s were patient complaints of barriers to care and piles of paperwork. What researchers would learn later was that such delivery models did not produce savings, and with a fee-for-service payment structure, healthcare costs kept increasing.

As the authors note, in those days there was no forum to challenge such thinking, and in that vacuum The American Journal of Managed Care was born to provide a place for peer-reviewed research to reach not only academics and practitioners but also leaders in health plans whose decisions affected the lives of patients and healthcare providers. Today, the journal has expanded to include The American Journal of Pharmacy Benefits, other publications, AJMCtv, and related conferences and media services.

“One cannot overstate how important The American Journal of Managed Care has been to the ongoing conversation about healthcare delivery in the United States,” said Brian Haug, AJMC president. “As our editors note, AJMC is no longer just a publication, but a platform for bringing together stakeholders from across the healthcare spectrum.”

Drs. Fendrick and Chernew review several highly cited papers that have appeared in AJMC, including their own landmark 2001 paper on “benefit-based co-pay” which has come to be called “value-based insurance design.” This concept calls for financial barriers to be lowered for high-value services and raised for low-value services, and it has become embedded in national healthcare policy. The Affordable Care Act, for example, eliminates co-pays for preventive services, with the idea that this helps patients avoid emergency department visits and hospitalizations in the future.

Research in 2006 by Goldman, Joyce, and Karaca-Mandic supported the value-based insurance design concept; the study found that by aligning co-pays with value in the treatment of high cholesterol, almost 80,000 hospitalizations and 31,000 visits to the emergency department could be avoided, bringing a savings of over $1 billion annually.

Other important studies highlighted in the review article include:

  •     Early reports by Gilfillian, et al, (2010) and Rosland, et al, (2013) involving Patient-Centered Medical Homes; the Gilfillian paper found the model can improve outcomes without increasing costs.
  •     Work by Hornberger, Cosler, and Lyman (2005) evaluated the economic effects of targeting chemotherapy for early-stage breast cancer. The model used by the authors predicted the risk of recurrence more accurately than existing guidelines, raising the potential to lower costs and improve outcomes.
  •     A 2005 review by Gibson, et al, on the impact of cost-sharing on the use of prescription drugs.
  •     Kosinski, et al, (2002) evaluated clinical effects of early treatment for rheumatoid arthritis. The authors found that early treatment can meaningfully improve patients’ health-related quality of life.

About the Journals

The American Journal of Managed Care celebrates its 20th year in 2015 as the leading peer-reviewed journal dedicated to issues in managed care. Other titles in the franchise include The American Journal of Pharmacy Benefits, which provides pharmacy and formulary decision-makers with information to improve the efficiency and health outcomes in managing pharmaceutical care, and The American Journal of Accountable Care, which publishes research and commentary on innovative healthcare delivery models facilitated by the 2010 Affordable Care Act. AJMC’s news publications, the Evidence-Based series, bring together stakeholder views from payers, providers, policymakers and pharmaceutical leaders in oncology and diabetes management. To order reprints of articles appearing in AJMC publications, please call (609) 716-7777, x 131.

CONTACT:    Nicole Beagin (609) 716-7777 x 131
        nbeagin(at)ajmc(dot)com
        http://www.ajmc.com

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Nicole Beagin
@AJMC_Journal
since: 07/2009
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