John Michael O'Brien, PharmD, MPH, discussed the changes in managed care over the past 30 years to commemorate the 30th anniversary of The American Journal of Managed Care®. Over my 30 years in health ...

Medicaid managed care policy shifts scheduled for 2026 are poised to affect how home care agencies process and submit claims significantly. New compliance benchmarks, reporting expectations, and data ...

With the tremendous growth of managed care over the last several years, the Medicare and Medicaid programs have had to transform how they fund health care for approximately 100 million enrollees.

A former state prosecutor said the private insurance companies that manage most of the Medicaid care in Minnesota were also “asleep at the wheel" when it came to detecting fraud.

The state’s largest health care workers’ union is renewing a legislative push to remove private, third-party insurers from the home care payment system, a policy it says could save the state $3.5 ...

Medicaid managed care organizations should prioritize children in low-opportunity neighborhoods to optimize health care utilization, improve minority health, and address health-related social needs.

With the announcement of the nursing home minimum staffing rule, I asked myself the same question as operators nationwide: how on earth are we going to pay for this? Even if nursing homes could find ...

To continue reading this content, please enable JavaScript in your browser settings and refresh this page. Despite many of the current health care challenges facing ...