Category: Statistics

J Manag Care Spec Pharm. 2025 Jul;31(7):723-728. doi: 10.18553/jmcp.2025.31.7.723.

ABSTRACT

BACKGROUND: Health plans have acknowledged there is a significant unmet need to improve prior authorization (PA) processes to increase patient access to life saving nonstatin therapies. Outcomes from a series of regional working groups in the United States provided recommendations for developing standardized patient eligibility criteria and a checklist for streamlining the PA process.

OBJECTIVE: To (1) develop a standardized PA checklist to streamline collection of adequate PA documentation by prescribers, regardless of health insurance plan type, and (2) measure the impact of the PA checklist in clinical practice in a controlled observational study.

METHODS: A working group of thought leaders representing payers and providers was assembled by PRIME Education, in collaboration with the Academy of Managed Care Pharmacy, the American Society for Preventive Cardiology, and the Preventive Cardiovascular Nurses Association. The working group developed and finalized a PA checklist for PCSK9 inhibitors that was integrated into the electronic medical record for 2 large community health care systems with geographic representation of patients with cardiovascular disease: Random chart audits were conducted prior to (historical controls) and 6 months after (post-intervention) implementation of the checklist (n = 100 each set). Primary study endpoints were rates of approvals and time to approval/receipt of prescribed drug. Statistical analyses measured changes in PA documentation outcomes, including treatment history and authorization approvals/denials. Survey questions provided to health care provider teams before and after integration of the PA checklist measured changes in prescriber attitudes on effectiveness and efficiency of the PA checklist.

RESULTS: Following implementation of the PA checklist, a 19% absolute increase in initial PA approvals and a 2-day overall reduction in time-to-treatment with prescribed PCSK9 inhibitor therapy were observed. Documentation of side effects (54%; P < 0.0001), statin contraindications (31%; P < 0.0001), and prior lipid therapies failed (20%; P < 0.0001) also increased postimplementation. In surveys, prescribers reported greater efficiency and effectiveness of the PA process when using the standardized PA checklist.

CONCLUSIONS: Time-to-treatment for nonstatin therapies for eligible patients with hypercholesterolemia was decreased in 2 community health systems following integration of a standardized PA checklist developed through a collaboration between patients and providers.

PMID:40577037 | DOI:10.18553/jmcp.2025.31.7.723

J Manag Care Spec Pharm. 2025 Jul;31(7):627-640. doi: 10.18553/jmcp.2025.31.7.627.

ABSTRACT

BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1 RA) or sodium-glucose cotransporter-2 inhibitors (SGLT2i) are recommended as first-line therapy for glycemic management for adults with type 2 diabetes and specific comorbidities. It is unknown whether there are meaningful differences in how GLP-1 RA vs SGLT2i therapy may affect health care resource utilization and medical costs.

OBJECTIVE: To compare health care resource utilization and costs in adults with type 2 diabetes newly initiating GLP-1 RA vs SGLT2i therapy.

METHODS: We used the Humana Healthcare Research database and a retrospective cohort study design to identify patients with type 2 diabetes, enrolled in a Medicare Advantage Prescription Drug plan from January 1, 2018, to June 30, 2022. Eligible patients had at least 2 pharmacy claims for a GLP-1 RA or SGLT2i drug and had at least 12 months of continuous enrollment prior to and after the first prescription claim. Propensity score matching adjusted for population differences between GLP-1 RA and SGLT2i groups. Subgroup analyses included patients with baseline atherosclerotic cardiovascular disease and obesity. Main outcomes included inpatient stays, emergency department visits, and all-cause health care costs in the 12-month follow-up period.

RESULTS: The 1:1 matched cohort consisted of 22,167 individuals each treated with SGLT2i or GLP-1 RA, had a mean age of 68.2 years, and was 52.2% female, 73.4% White, and 18.6% Black. There were no significant differences in all-cause or diabetes-related inpatient stays or emergency department visits between GLP-1 RA and SGLT2i users for overall and subgroup analyses. Compared with SGLT2i patients, those on GLP-1 RA had 3.1% (95% CI = 0.9%-5.3%) higher medical costs in the overall cohort but 2.9% (95% CI = -5.5% to -0.2%) lower medical costs in the obesity subgroup. Pharmacy costs for patients on GLP-1 RA were 6% to 9% higher for overall and subgroup analyses, resulting in 4% to 6% higher total health care costs for GLP-1 RA users relative to SGLT2i users.

CONCLUSIONS: There were no significant differences in health care resource utilization in the overall cohort between patients taking GLP-1 RA vs those taking SGLT2i, and pharmacy and total health care costs were higher in the GLP-1 RA group. In the obesity subgroup, GLP-1 RA initiators had lower medical costs.

PMID:40577036 | DOI:10.18553/jmcp.2025.31.7.627

Acta Cardiol. 2025 Jun 27:1-9. doi: 10.1080/00015385.2025.2524239. Online ahead of print.

ABSTRACT

AIMS: To document the cross-prevalence of overall macro- and microangiopathy in T2DM and identify common and vessel-size-specific variables associated with comorbidities.

METHODS: Cross-sectional study of 876 T2DM patients to assess frequency of macrovascular and microvascular target organ damage (TOD). Logistic regressions were performed to identify common and specific variables linked to TODs.

RESULTS: Overall prevalence of Mic and Mac were 41% and 33%, respectively; 45.5% had no comorbidities (Mic[-]Mac[-]); 21% had microangiopathy only (Mic[+]Mac[-]), 13.5% had macroangiopathy only (Mic[-]Mac[+]); 20% both (Mic[+]Mac[+]). Compared to Mic[-]Mac[-], the 3 TOD groups had more (micro)albuminuria. Mic[-]Mac[+] and Mic[+]Mac[+] had more diabetic foot (DF) and heart failure (HF) than Mic[-]Mac[-]. Mic[+]Mac[+] suffered more often from atrial fibrillation than Mic[-]Mac[-]. Mic[+]Mac[+] suffered twice more from peripheral artery disease and thrice higher DF, and 1.5 times more HF vs. Mic[-]Mac[+]. Non-HDL-C, remnant cholesterol, sleep apnoea and non-O blood group were associated with Mic/Mac.

CONCLUSIONS: This transversal analysis provides quantitative data on cross-prevalence of micro- and macroangiopathies in a 3rd line hospital. Small and large-vessel diseases are highly intertwined with atherosclerotic, cardiometabolic and cardiorenal co-morbidities.

PMID:40577026 | DOI:10.1080/00015385.2025.2524239

JAMA Netw Open. 2025 Jun 2;8(6):e2517095. doi: 10.1001/jamanetworkopen.2025.17095.

ABSTRACT

IMPORTANCE: Many US communities face a crisis of people experiencing unsheltered homelessness often intertwined with opioid use. Jurisdictions seek policy options for managing unsanctioned encampments of this population, but their various outcomes are unclear.

OBJECTIVE: To evaluate policy options and their health and economic outcomes for an encampment of people experiencing homelessness and opioid use disorder (OUD).

DESIGN, SETTING, AND PARTICIPANTS: This decision analytical model study conducted a closed-cohort state-transition simulation using the Researching Effective Strategies to Prevent Opioid Death (RESPOND) model from October 2021 to October 2022. The study was based primarily on data from Massachusetts and simulated an urban encampment with a population experiencing homelessness and high-risk opioid use. Data analysis was performed from December 2022 to October 2024.

EXPOSURE: The following encampment management strategies were modeled: (1) status quo (no sweep); (2) sweep, a sudden disruption of all residents, followed by no additional resources; (3) housing with medication for opioid use disorder (MOUD) requirement; or (4) housing without MOUD requirement.

MAIN OUTCOMES AND MEASURES: The primary outcomes were overdose and all-cause mortality per 1000 person-years, weeks spent in housing and taking MOUD, and economic cost from a modified government payer perspective. Sensitivity analyses were conducted by varying uncertain parameters.

RESULTS: The simulated cohort included 400 adults (mean [SD] age, 48 [17] years; 232 males [58.0%]). Under the status quo strategy, there were 50.4 (95% uncertainty interval [UI], 48.9-52.2) deaths per 1000 person-years, 15.5 (95% UI, 14.0-17.2) deaths from overdose per 1000 person-years, and 2990 (95% UI, 2897-3081) person-weeks spent taking MOUD for a total cost of $6 583 000 (95% UI, $6 502 000-$6 660 000). A sweep strategy resulted in 53.1 (95% UI, 51.3-55.2) deaths per 1000 person-years, 16.4 (95% UI, 18.2-20.2) deaths from overdose per 1000 person-years, and 1694 (95% UI, 1625-1764) person-weeks spent taking MOUD at a total cost of $6 820 000 (95% UI, $6 736 000-$6 899 000). The housing with medication requirement strategy resulted in 51.2 (95% UI, 49.4-53.0) deaths per 1000 person-years, 16.3 (95% UI, 14.6-18.1) deaths from overdose per 1000 person-years, and 3050 (95% UI, 3025-3075) person-weeks spent taking MOUD and in housing, for a total cost of $7 264 000 (95% UI, $7 188 000-$7 336 000). A housing without MOUD requirement strategy resulted in 49.2 (95% UI, 47.6-51.1) deaths per 1000 person-years, 14.3 (95% UI, 12.7-16.2) deaths from overdose per 1000 person-years, and 5014 (95% UI, 4942-5085) person-weeks spent taking MOUD and 14 511 (95% UI, 14 461-14 562) person-weeks spent in housing, for a total cost of $8 822 000 (95% UI, $8 774 000-$8 868 000).

CONCLUSIONS AND RELEVANCE: In this decision analytical model study of approaches to homeless encampments involving individuals with OUD, sweeps increased mortality and spending. Housing without MOUD requirement was the most costly strategy but saved more lives.

PMID:40577017 | DOI:10.1001/jamanetworkopen.2025.17095

JAMA Netw Open. 2025 Jun 2;8(6):e2517103. doi: 10.1001/jamanetworkopen.2025.17103.

ABSTRACT

IMPORTANCE: The number of people experiencing homelessness (PEH) in the US has increased substantially in recent years. The leading cause of death among PEH is drug overdose, with opioids accounting for the majority of such deaths.

OBJECTIVE: To assess the costs and health outcomes of providing stable housing to PEH who have opioid use disorder (OUD).

DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation conducted a model-based cost-effectiveness analysis of PEH with OUD in the US.

EXPOSURE: Provision of stable housing, with no requirement to enter OUD treatment.

MAIN OUTCOMES AND MEASURES: Primary outcomes were overdoses and deaths over 5 years, lifetime per-person discounted quality-adjusted life-years (QALYs) and costs, and incremental cost-effectiveness ratios (ICERs) compared with the status quo (no housing provision).

RESULTS: In a model of 1000 PEH (700 male; mean [SD] age, 46.4 [14.0]; 300 female; mean [SD] age, 46.5 [14.3]), under the status quo, 191 (95% CI, 152-237) deaths occurred over 5 years (58 [95% CI, 44-78] from overdose and 133 [95% CI, 101-167] from other causes). With the housing intervention, 140 (95% CI, 114-185) deaths occurred (53 [95% CI, 39-76] from overdose and 87 [95% CI, 73-110] from other causes). The housing intervention was associated with a gain of 3.59 (95% CI, 3.13-3.98) lifetime QALYs per person at an incremental cost of $26 800 (95% CI, $21 200-$32 300) per QALY gained compared with the status quo. Over extensive sensitivity analyses, the ICER remained less than $90 000 per QALY gained.

CONCLUSIONS AND RELEVANCE: This economic evaluation found that investing in stable housing for this marginalized population, even with no requirement to enter OUD treatment, was associated with cost-effectiveness, fewer deaths, and improved health outcomes. Efforts are urgently needed to improve the health of PEH with OUD; it is essential to understand the outcomes and cost-effectiveness of housing provision for this marginalized population because housing status is a key social determinant of health.

PMID:40577016 | DOI:10.1001/jamanetworkopen.2025.17103

JAMA Netw Open. 2025 Jun 2;8(6):e2517760. doi: 10.1001/jamanetworkopen.2025.17760.

ABSTRACT

IMPORTANCE: Accurate estimation of surgical transfusion risk is important for perioperative planning and effective resource allocation. Most machine learning models in health care are not validated or perform poorly in external settings.

OBJECTIVE: To externally validate a publicly available machine learning algorithm (Surgical Personalized Anticipation of Transfusion Hazard [S-PATH]) to estimate red cell transfusion during surgery within a national sample of hospitals.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study evaluated all surgical cases performed in 2020 or 2021 at 45 US hospitals participating in the Multicenter Perioperative Outcomes Group. Obstetric and nonoperative cases were excluded. Data analysis was performed from February 2023 to March 2025.

EXPOSURES: At each hospital, S-PATH was used to estimate surgical transfusion risk using patient- and procedure-specific characteristics without local retraining. A baseline model representing the standard-of-care maximum surgical blood ordering schedule (MSBOS) approach, which omits patient factors, was used for comparison. Risk thresholds above which a type and screen would be recommended were set for 96% sensitivity. Performance was evaluated at each hospital separately.

MAIN OUTCOMES AND MEASURES: The primary outcome was the difference in the percentage of patients with type and screen order recommendations between S-PATH and MSBOS at each hospital. The secondary outcome was area under the receiver operating characteristic curve (AUROC).

RESULTS: In this cohort study of 3 275 956 surgical cases (median [IQR] age, 57 [40-69] years; 53.1% female) performed at 45 hospitals (28 of 45 academic [62.2%]), S-PATH recommended type and screen orders for a median (IQR) of 32.5% (25.8%-42.0%) of cases, whereas the MSBOS approach recommended type and screens for a median (IQR) of 51.6% (46.9%-61.1%) of cases for the same sensitivity (median [IQR] difference, 17.9 [14.8-24.9] absolute percentage points). The median (IQR) S-PATH AUROC was 0.929 (0.915-0.946), whereas the median (IQR) MSBOS AUROC was 0.857 (0.822-0.884).

CONCLUSIONS AND RELEVANCE: In this cohort study of 45 hospitals, a personalized surgical transfusion risk prediction algorithm demonstrated external validity and discrimination. S-PATH was consistently more effective than standard care, suggesting its potential for use as a perioperative clinical decision support tool.

PMID:40577014 | DOI:10.1001/jamanetworkopen.2025.17760

JAMA Netw Open. 2025 Jun 2;8(6):e2517825. doi: 10.1001/jamanetworkopen.2025.17825.

ABSTRACT

IMPORTANCE: Surgeon training with a specific implant is often not considered in implant registry-based studies, which may lead to unobserved confounding bias. Discrepancies between registry and clinical trial outcomes for patellofemoral arthroplasty (PFA) may originate from differences in surgeon training levels.

OBJECTIVE: To compare revision rates for knees operated on by knee surgeons specifically trained for PFA and knee surgeons who were not.

DESIGN, SETTING, AND PARTICIPANTS: In this population-based cohort study, the framework of a target trial was used to compare outcomes for 2 patient groups: patients who underwent PFA performed by knee surgeons who had (trial surgeons) vs who had not (nontrial surgeons) received focused PFA training as part of a randomized clinical trial. All primary PFA procedures from January 1, 2008, through December 31, 2015, were identified using Danish registries and individual hospital notes with 6 years’ follow-up. Data were analyzed from January 24 to March 1, 2024.

EXPOSURE: Focused PFA training.

MAIN OUTCOMES AND MEASURES: The primary outcome was 6-year risk of revision. Analyses were conducted according to a prespecified statistical analysis plan, using multiple logistic regression to estimate marginal risk ratios for 6-year risks of revision, reoperation, and mortality, adjusting for potential confounders.

RESULTS: Of 482 eligible knees of patients who had undergone PFA, 274 (57%; 206 female [75%]; mean [SD] age, 61 [13] years) were operated on by trial surgeons, and 208 (43%; 142 female [68%]; mean [SD] age, 57 [12] years) by nontrial surgeons. Trial surgeons operated on knees with higher patellofemoral Kellgren-Lawrence osteoarthritis grade (range 0-4, with 0 indicating no osteoarthritis and 4 indicating severe osteoarthritis) than nontrial surgeons (79% vs 53% with grade 3 to 4) and higher tibiofemoral Kellgren-Lawrence osteoarthritis grades (37% vs 17% with grade 2 to 4). The 6-year revision rate for trial surgeons was 8% (22 of 274 knees) vs 26% (54 of 208 knees) for nontrial surgeons, corresponding to an adjusted relative risk (RR) of 0.35 (95% CI, 0.22-0.56; P < .001). The reoperation rate was 12% (33 of 274 knees) for trial surgeons vs 19% (40 of 208 knees) for nontrial surgeons, with an adjusted RR of 0.71 (95% CI, 0.42-1.18; P = .19). There was no difference in mortality for trial vs nontribal surgeon groups (18 of 274 knees [7%] vs 12 of 208 knees [6%]; adjusted RR, 1.11 [95% CI, 0.53-2.33; P = .79).

CONCLUSIONS AND RELEVANCE: In this cohort study using a target trial emulation approach to assess the association of surgeon training with PFA outcomes, the cumulative 6-year revision rate for PFA was lower for knees operated on by PFA-trained knee surgeons, suggesting that such surgeon training was associated with a better outcome. This suggests that the level of training may be an important confounder for registry-based comparisons of implant outcome, and that this confounder may even obscure inherent implant outcomes.

PMID:40577013 | DOI:10.1001/jamanetworkopen.2025.17825

JAMA Netw Open. 2025 Jun 2;8(6):e2517965. doi: 10.1001/jamanetworkopen.2025.17965.

ABSTRACT

IMPORTANCE: Prescriptions for potentially inappropriate medications are common and, by definition, may carry risks that outweigh benefits.

OBJECTIVE: To determine whether interventions to address potentially inappropriate prescribing for older primary care patients are associated with changes in the number of medications prescribed, drug-related harms, hospitalizations, and mortality.

DATA SOURCES: MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to September 6, 2024.

STUDY SELECTION: Randomized clinical trials of interventions to address potentially inappropriate prescribing for older primary care patients (aged ≥65 years) residing in the community or in long-term care facilities, such as nursing homes or assisted-living facilities, were included.

DATA EXTRACTION AND SYNTHESIS: Two researchers independently screened the records and abstracted data using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline. Data were pooled using random-effects models.

MAIN OUTCOMES AND MEASURES: The planned outcomes were the number of medications, nonserious adverse drug reactions, injurious falls, quality of life, medical visits, emergency department visits, hospitalizations, and all-cause mortality. Random-effects meta-analyses were performed using the inverse variance method for similar studies, reporting risk ratios (RRs) or standardized mean differences (SMDs). Heterogeneity was assessed with I2 values, and publication bias was assessed with funnel plots and the Egger regression test.

RESULTS: Of the 14 649 records identified, 118 randomized clinical trials (comprising 417 412 patients) were included in this review. Interventions to address potentially inappropriate prescribing were associated with a reduction in the number of medications prescribed (SMD, -0.25 [95% CI, -0.38 to -0.13]), equivalent to approximately 0.5 fewer medications per patient. However, there were no substantial differences in the other outcomes, including nonserious adverse drug reactions (RR, 0.92 [95% CI, 0.58-1.46]), injurious falls (SMD, 0.01 [95% CI, -0.12 to 0.14]), quality of life (SMD, 0.09 [95% CI, -0.04 to 0.23]), medical visits (SMD, 0.02 [95% CI, -0.02 to 0.07]), emergency department admissions (RR, 1.02 [95% CI, 0.96-1.08]), hospitalizations (RR, 0.95 [95% CI, 0.89-1.02]), or all-cause mortality (RR, 0.94 [95% CI, 0.85-1.04]).

CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis, interventions to address potentially inappropriate prescribing were associated with reductions in the number of medications prescribed, with no substantial change in other outcomes. These findings suggest that inappropriate prescribing interventions may be implemented to safely reduce the number of medications prescribed to older adults in the primary care setting. Future studies should continue to evaluate these interventions using standardized criteria and consistently report potential harms to support data synthesis and capture key outcomes such as quality of life, hospitalization, and mortality.

PMID:40577011 | DOI:10.1001/jamanetworkopen.2025.17965

JAMA Health Forum. 2025 Jun 7;6(6):e251467. doi: 10.1001/jamahealthforum.2025.1467.

ABSTRACT

IMPORTANCE: Many individuals in the US face a high risk of losing their health insurance coverage and experiencing insurance churn, especially those enrolled in Medicaid. Prior research has found that the risk of losing insurance coverage remains high in the US even after the Patient Protection and Affordable Care Act significantly reduced the number of uninsured individuals.

OBJECTIVE: To estimate whether the Families First Coronavirus Response Act (FFCRA) decreased insurance churn.

DESIGN, SETTING, AND PARTICIPANTS: This study used 2 quasi-experimental approaches: an interrupted time series approach and a difference-in-difference approach. Both approaches use individual-level data from the Medical Expenditure Panel Survey from January 2015 to December 2022. In the difference-in-difference analysis comparing individuals with Medicaid to individuals with private health insurance coverage, the probability that insured individuals aged 2 to 64 years lose insurance over the next 12 months before and after the FFCRA was estimated. Data were analyzed from January to November 2024.

MAIN OUTCOMES AND MEASURES: Primary outcome was the share of insured individuals who lost insurance coverage over the next 12 months. This measure was defined for all insured individuals and defined separately for individuals with Medicaid and for individuals with private insurance coverage.

RESULTS: The sample included 96 473 individuals. Of these, 46 779 (49.7%) were male, and the mean (SD) age was 31.9 (18.1) years. In the interrupted time series analysis, the FFCRA was associated with a reduction in insurance churn by 2.06 percentage points (β = -0.021; 95% CI, -0.024 to -0.018; P < .001). In the difference-in-difference analysis, the FFRCA reduced Medicaid churn by 5.51 percentage points (β = -0.055; 95% CI, -0.060 to -0.050; P < .001). Combining these estimates, 65.0% (95% CI, 54.8-75.3) of the reduction in insurance churn came from the reduction in Medicaid churn.

CONCLUSIONS AND RELEVANCE: In this study, the FFCRA was associated with a significantly decreased risk of losing health insurance. Without the FFCRA, an estimated 2.94 million individuals with Medicaid would have lost insurance coverage each year during the COVID-19 public health emergency.

PMID:40577007 | DOI:10.1001/jamahealthforum.2025.1467

JAMA Health Forum. 2025 Jun 7;6(6):e251630. doi: 10.1001/jamahealthforum.2025.1630.

ABSTRACT

IMPORTANCE: The American Rescue Plan of 2021 allowed states to expand pregnancy Medicaid coverage to 12 months post partum. How the new policy affects Medicaid coverage and health care utilization is largely unknown.

OBJECTIVES: To quantify insurance coverage and care utilization for postpartum individuals under Medicaid policies that extended postpartum coverage to 12 months after delivery from 60 days.

DESIGN, SETTING, AND PARTICIPANTS: A retrospective study of Medicaid coverage and utilization in North Carolina using Medicaid claims from March 2016 to December 2023 was conducted. All Medicaid-funded births in North Carolina from January 2017 through December 2022 were included.

EXPOSURE: A total of 3 periods were differentiated: before the COVID-19 public health emergency (PHE), during the PHE when there was a moratorium on Medicaid disenrollment, and after North Carolina adopted the 12-month postpartum extension through the American Rescue Plan of 2021.

MAIN OUTCOMES AND MEASURES: Length and type of postpartum Medicaid enrollment were evaluated. Utilization outcomes included indicators of (1) the receipt of at least 1 postpartum visit; (2) any contraceptive visit; (3) any primary care visit; (4) any outpatient mental health care, and (5) any outpatient substance use disorder (SUD) care.

RESULTS: There were 353 957 Medicaid-funded births in North Carolina from January 2017 through December 2022. During the postpartum extension, Medicaid recipients were more likely to have been continuously covered by comprehensive Medicaid at 12 months post partum (97.1% vs 26.5% pre-PHE). Beneficiaries in the extended coverage cohorts were substantially more likely to use Medicaid-financed care than those in the pre-PHE cohort for contraception (47.8% for the PHE cohort and 47.9% for the extension cohort vs 38.0% for the pre-PHE cohort), primary care (68.1% for the PHE cohort and 71.4% for the extension cohort vs 25.3% for the pre-PHE cohort), mental health (22.1% for the PHE cohort and 25.7% for the extension cohort vs 7.5% for the pre-PHE cohort) and substance use disorder visits (3.6% for the PHE cohort and 5.3% for the extension cohort vs 2.2%for the pre-PHE cohort) within 12 months, although there was evidence of delays in early postpartum and contraceptive visits.

CONCLUSIONS AND RELEVANCE: Results of this study suggest that extending Medicaid coverage for 12 months post partum was associated with expanded opportunities for greater access to Medicaid-financed medical and behavioral health care. Both prevention and ongoing treatment of chronic conditions may help mitigate key adverse outcomes. Findings may help policymakers and public health officials understand how extended coverage affects access to Medicaid-financed care.

PMID:40577006 | DOI:10.1001/jamahealthforum.2025.1630