The use of remote physiologic monitoring (RPM)-the remote transmission of patients' physiologic measures (such as blood pressure) to care teams-has grown rapidly. For practices, establishing an RPM program can improve patient care and increase revenue, but it may also require substantial investment, including hiring new staff. No prior work has quantified the impact of RPM on practices, such as its effects on practice revenue, care delivery, and resource allocation across patients. Using national Medicare claims, we identified 754 primary care practices that began billing for RPM during the period 2019-21 and examined practice-level outcomes through 2023. After these practices adopted RPM, Medicare revenue increased by 20.0percent relative to similar, matched, nonadopting practices. This was driven by direct billing for RPM as well as more outpatient visits and care management services. Although adopting practices experienced a 2.7percent increase in billing providers, revenue increases were predominantly driven by increased activity per provider. Increases in care volume for patients receiving RPM did not seem to come at the expense of other patients.

Adults with employer-sponsored insurance may remain in employment to retain health coverage for their children-a phenomenon we term dependent-related job lock. Using 2016-23 National Survey of Children's Health data, we estimated the prevalence of dependent-related job lock among families with children covered by employer-sponsored insurance and examined associations with caregivers' health. Nationally, 8.9percent of such families reported dependent-related job lock, with higher rates seen among families with children with special health care needs, particularly those with emotional, behavioral, and developmental problems (23.1percent). Dependent-related job lock was associated with a 4.5-7.1-percentage-point increase in poor or fair caregiver mental health and a 3.7-4.3-percentage-point increase in poor or fair caregiver physical health across groups of children with special health care needs. Sensitivity analyses adjusting for employment suggested some confounding. Findings underscore the need for policy reforms to address insurance-related barriers, reduce disparities in caregivers' health, and promote equitable employment mobility.

Interchangeability, a Food and Drug Administration (FDA) designation allowing pharmacists to substitute a biosimilar for its branded originator at the point of sale, is intended to increase biosimilar adoption. However, little is known about the relationship between interchangeability and biosimilar adoption. We conducted an interrupted time-series analysis to examine this relationship for Semglee, which gained interchangeability in July2021, in Medicaid and the employer-sponsored insurance market in 2021-22. Semglee is a biosimilar for Lantus (insulin glargine), the most-prescribed long-acting insulin in the US. We found that Semglee market share increased by 3.70percentage points in Medicaid and 19.25percentage points in employer-sponsored insurance beginning in the first quarter of 2022, coinciding with improved Semglee coverage, especially in employer-sponsored insurance. State-level variation in pharmacist substitution laws was not associated with Semglee adoption. These results suggest that increased adoption was mediated mainly through improved insurance coverage, with no detectable role for increased prescribing alone and only a secondary role, at most, for pharmacist substitution. Semglee's gains in market share after interchangeability suggest that easing of federal interchangeability requirements may moderately spur biosimilar adoption.

Prior authorization is a barrier to accessing medications for opioid use disorder (MOUD). Although private insurance covered about one-third of patients with OUD in 2023, the understanding of prior authorization prohibitions in private insurance remains limited. We synthesized state laws prohibiting prior authorization for MOUD in private insurance in the US. The number of states with such prohibitions grew from two in 2015 to twenty-two in 2023, with variations in the scope of these prohibitions. Seven states have fully prohibited prior authorization for all MOUD ("full prohibitions") since the effective date. Fifteen states adopted legislation that still allows prior authorization under some conditions ("partial prohibitions," including those covering at least one of any MOUD; those covering one of each MOUD; and those with limitations based on modality or formulation, generic or branded status, prior authorization frequency, prescription duration, or emergency conditions). Among these fifteen states, four states transitioned from partial prohibitions to full prohibitions, and eleven states maintained partial prohibitions, although many have broadened the scope of prohibitions over time. The proliferation of prior authorization prohibitions for MOUD highlights that this is an area of significant state legislative focus.

Under the Consolidated Appropriations Act, 2023, which required the provision of national twelve-month continuous Medicaid eligibility for children up to age nineteen, children's Medicaid enrollment increased. After implementation of the act, states without prior twelve-month continuous eligibility showed larger gains in children's enrollment than states with prior continuous eligibility. These gains occurred during the unwinding of COVID-19 pandemic-era protections.

During the past several decades, physicians have transitioned from small, physician-owned practices to larger practices owned by corporations such as hospitals, private equity firms, and health insurers. UnitedHealth Group, the largest US health care company by revenue, sells insurance products under the UnitedHealthcare brand while providing health care services under the Optum brand, which has more than 90,000 aligned physicians. Although there are benefits to insurer-physician integration, potential concerns include regulatory gaming of the medical loss ratio and partial foreclosure of rival physician practices. This descriptive study used Centers for Medicare and Medicaid Services payer transparency data for the employer-sponsored and individual markets to show that when the relative price paid to Optum versus non-Optum providers is analyzed, UnitedHealthcare's payments are 17percent higher than the relative price of its competitors. In markets where UnitedHealthcare has 25percent or more market share, this percentage increases to 61percent. The results suggest that intercompany transactions within health care conglomerates may warrant scrutiny, as they may be signals of regulatory gaming or attempted foreclosure.

Recent federal and state policies have been facilitating the participation of federally qualified health centers (FQHCs) in value-based payment programs to transform care delivery for underserved populations. However, evidence regarding FQHCs' value-based payment revenue and its relationship with the quality of care is limited. Using administrative data from all FQHCs in the US, we assessed trends in the centers' value-based payment and capitation revenue penetration during the period 2014-23 and examined the associations of quality outcomes with the receipt of these revenues. Although value-based payment and capitation revenue penetration increased over time, only 51.2percent of FQHCs received value-based payment and 34.1percent received capitation payment in 2023, accounting for an average of 2.4percent and 9.4percent of patient revenue, respectively. Receiving value-based payment was associated with increased levels in seven of nine quality measures relevant to preventive and primary care. Our findings suggested potential quality improvement effects of value-based payment, although barriers for FQHCs to participating in these programs may still exist.

A disclosure during a routine checkup prompts an alternative approach to mandated reporting.

The number of laws authorizing pharmacists to prescribe contraception is increasing across the US. We used national pharmacy claims to document pharmacist-prescribed contraception (contraceptive pill, patch, and ring) in twenty states allowing pharmacist prescribing in 2022. That year, pharmacist prescriptions made up only a small share of overall prescribing for these methods, and the average prescribing pharmacist wrote fewer than ten new prescriptions.

Using data from the Current Population Survey, we examined trends in median earnings among health care workers during the period 2015-24. We found that the workers in the lowest-earning occupations in the health care professions experienced gains of approximately 13percent in this period-significantly higher than other groups.