Growth in Hospital-Led Payer-Integration—Improving Care or Consolidating Markets?
https://jamanetwork.com/journals/jama/fullarticle/2849761
Traditionally, health plans manage payment for care, while clinicians deliver care. Although these roles have typically been distinct, organizations have increasingly merged these functions, integrating care and coverage. The largest health insurers in the US now also operate extensive physician networks, while health systems are increasingly acquiring or partnering with payers. These payer-provider integrated entities, often referred to as payviders, are a variation of earlier integrated models and are driven by more contemporary features of the health care delivery landscape, including Medicare Advantage expansion, value-based care payment reforms, substantial capital investment in health care organizations, and limited federal oversight of vertical integration.
https://jamanetwork.com/journals/jama/fullarticle/2849761
Traditionally, health plans manage payment for care, while clinicians deliver care. Although these roles have typically been distinct, organizations have increasingly merged these functions, integrating care and coverage. The largest health insurers in the US now also operate extensive physician networks, while health systems are increasingly acquiring or partnering with payers. These payer-provider integrated entities, often referred to as payviders, are a variation of earlier integrated models and are driven by more contemporary features of the health care delivery landscape, including Medicare Advantage expansion, value-based care payment reforms, substantial capital investment in health care organizations, and limited federal oversight of vertical integration.
Adverse Effects and Treatment Discontinuation of Blood Pressure–Lowering Drugs and Combinations
https://jamanetwork.com/journals/jama/fullarticle/2849512
This network meta-analysis of short-term randomized clinical trials examines adverse effects and treatment discontinuation associated with blood pressure–lowering therapies and their combinations, by drug class and regimen.
https://jamanetwork.com/journals/jama/fullarticle/2849512
This network meta-analysis of short-term randomized clinical trials examines adverse effects and treatment discontinuation associated with blood pressure–lowering therapies and their combinations, by drug class and regimen.
Breaking Up Health Care Conglomerates—The Right Fix Right Now?
https://jamanetwork.com/journals/jama/fullarticle/2849509
This Viewpoint discusses breaking up health care conglomerates to decrease the cost of health care insurance.
https://jamanetwork.com/journals/jama/fullarticle/2849509
This Viewpoint discusses breaking up health care conglomerates to decrease the cost of health care insurance.
Minimizing Adverse Effects in Hypertension Treatment
https://jamanetwork.com/journals/jama/fullarticle/2849519
Approximately 116 million people in the US and 1.4 billion worldwide have hypertension. In the US, among people aged 40 to 59 years, approximately 53% have hypertension, and among people 60 years and older, 71.6% have hypertension. Hypertension is a major risk factor for cardiovascular morbidity and mortality, and lowering blood pressure in people with hypertension meaningfully reduces this risk. In a network meta-analysis of 42 randomized clinical trials and 144 220 people with hypertension, systolic blood pressure lowering by 10, 20, or 30 mm Hg to achieve a treatment goal of 120 to 124 mm Hg was associated with reductions in cardiovascular disease events of 29%, 42%, and 54%, respectively. Most people with hypertension require multiple antihypertensive medications to effectively control their blood pressure.
https://jamanetwork.com/journals/jama/fullarticle/2849519
Approximately 116 million people in the US and 1.4 billion worldwide have hypertension. In the US, among people aged 40 to 59 years, approximately 53% have hypertension, and among people 60 years and older, 71.6% have hypertension. Hypertension is a major risk factor for cardiovascular morbidity and mortality, and lowering blood pressure in people with hypertension meaningfully reduces this risk. In a network meta-analysis of 42 randomized clinical trials and 144 220 people with hypertension, systolic blood pressure lowering by 10, 20, or 30 mm Hg to achieve a treatment goal of 120 to 124 mm Hg was associated with reductions in cardiovascular disease events of 29%, 42%, and 54%, respectively. Most people with hypertension require multiple antihypertensive medications to effectively control their blood pressure.
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The Influence of Urology on Longevity
https://jamanetwork.com/journals/jama/fullarticle/2849518
B. A. Thomas, M.D., Philadelphia
https://jamanetwork.com/journals/jama/fullarticle/2849518
B. A. Thomas, M.D., Philadelphia
Growing Trends in the Payvider Model and US Hospital Systems Owning Health Plans, 2018-2023
https://jamanetwork.com/journals/jama/fullarticle/2849517
This study uses American Hospital Association Annual Survey data to examine current trends in hospital-led payvider models.
https://jamanetwork.com/journals/jama/fullarticle/2849517
This study uses American Hospital Association Annual Survey data to examine current trends in hospital-led payvider models.
Nalbuphine for Cough Caused by Idiopathic Pulmonary Fibrosis
https://jamanetwork.com/journals/jama/fullarticle/2849515
To the Editor In the CORAL randomized clinical trial, Dr Molyneaux and colleagues reported that nalbuphine ER reduced 24-hour objective cough frequency in patients with IPF and chronic cough. Higher doses led to more significant reductions compared with placebo after 6 weeks. Although this study addresses a critical unmet need, several aspects require clarification to facilitate its clinical application.
https://jamanetwork.com/journals/jama/fullarticle/2849515
To the Editor In the CORAL randomized clinical trial, Dr Molyneaux and colleagues reported that nalbuphine ER reduced 24-hour objective cough frequency in patients with IPF and chronic cough. Higher doses led to more significant reductions compared with placebo after 6 weeks. Although this study addresses a critical unmet need, several aspects require clarification to facilitate its clinical application.
Nalbuphine for Cough Caused by Idiopathic Pulmonary Fibrosis
https://jamanetwork.com/journals/jama/fullarticle/2849516
To the Editor Dr Molyneaux and colleagues report the CORAL randomized clinical trial evaluating extended-release (ER) nalbuphine for idiopathic pulmonary fibrosis (IPF)–associated cough, an area where evidence-based options remain limited. By pairing 24-hour digital cough monitoring with patient-reported measures, the study provides a useful template for antitussive trials in interstitial lung disease.
https://jamanetwork.com/journals/jama/fullarticle/2849516
To the Editor Dr Molyneaux and colleagues report the CORAL randomized clinical trial evaluating extended-release (ER) nalbuphine for idiopathic pulmonary fibrosis (IPF)–associated cough, an area where evidence-based options remain limited. By pairing 24-hour digital cough monitoring with patient-reported measures, the study provides a useful template for antitussive trials in interstitial lung disease.
Audio Highlights May 29, 2026
https://jamanetwork.com/journals/jama/fullarticle/2849871
Listen to the JAMA Editor’s Summary for an overview and discussion of the important articles appearing in JAMA.
https://jamanetwork.com/journals/jama/fullarticle/2849871
Listen to the JAMA Editor’s Summary for an overview and discussion of the important articles appearing in JAMA.
Multicancer Detection Tests
https://jamanetwork.com/journals/jama/fullarticle/2849769
Blood-based multicancer detection (MCD) technologies have been touted as a revolution in early-stage population screening and testing for a wide range of cancers. MCDs (often called liquid biopsies) look for fragments of DNA and other biomarkers in the blood, which may indicate the presence of cancer and predict where it originated. The seductive premise has been clear: detecting cancer earlier and intervening at an earlier stage will cure more patients. Given this promise, the commercial market has grown to more than 24 companies, and the annual global market for these MCD technologies is estimated to reach US $2.9 billion by 2030.
https://jamanetwork.com/journals/jama/fullarticle/2849769
Blood-based multicancer detection (MCD) technologies have been touted as a revolution in early-stage population screening and testing for a wide range of cancers. MCDs (often called liquid biopsies) look for fragments of DNA and other biomarkers in the blood, which may indicate the presence of cancer and predict where it originated. The seductive premise has been clear: detecting cancer earlier and intervening at an earlier stage will cure more patients. Given this promise, the commercial market has grown to more than 24 companies, and the annual global market for these MCD technologies is estimated to reach US $2.9 billion by 2030.
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Spillover Effects in Clinical Trials
https://jamanetwork.com/journals/jama/fullarticle/2849768
The conduct of randomized clinical trials (RCTs) is often a large-scale endeavor, with the potential to impact patients, clinicians, health care systems, and even the communities in which they are carried out. The effects of trials on participants may flow through the randomized study treatments or through other pathways, for example, by inducing changes to aspects of care separate from the randomized treatments. These effects may be beneficial (eg, participants may receive more careful evaluation, additional diagnostic studies, closer follow-up, or earlier detection of complications) or they may be harmful (eg, inconvenience or financial costs).
https://jamanetwork.com/journals/jama/fullarticle/2849768
The conduct of randomized clinical trials (RCTs) is often a large-scale endeavor, with the potential to impact patients, clinicians, health care systems, and even the communities in which they are carried out. The effects of trials on participants may flow through the randomized study treatments or through other pathways, for example, by inducing changes to aspects of care separate from the randomized treatments. These effects may be beneficial (eg, participants may receive more careful evaluation, additional diagnostic studies, closer follow-up, or earlier detection of complications) or they may be harmful (eg, inconvenience or financial costs).
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Cancer Diagnostic Delay After Cell-Free DNA Multicancer Early Detection Testing
https://jamanetwork.com/journals/jama/fullarticle/2849767
This cross-sectional study uses data from cancer alliance regions in England to assess whether regional participation in a population-based screening trial of a cell-free DNA-based multicancer early detection test was associated with changes in cancer diagnostic delay rates.
https://jamanetwork.com/journals/jama/fullarticle/2849767
This cross-sectional study uses data from cancer alliance regions in England to assess whether regional participation in a population-based screening trial of a cell-free DNA-based multicancer early detection test was associated with changes in cancer diagnostic delay rates.
Hazards of Incentivizing “Repeat Until Normal” as a Strategy for Blood Pressure Control
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2849751
Each day in the US, more than 100 000 patients with hypertension are seen in office-based health care visits. A familiar scene at many of these visits begins with an initial blood pressure (BP) measurement of around 143/85 mm Hg, often measured on the way to the patient room, or immediately on entering and settling in for the visit. A repeat BP measurement, after conversation and cuff adjustment, reads 138/82 mm Hg. Clinically, this is routine variability. Administratively, however, it differentiates controlled from uncontrolled hypertension and may determine whether a clinician meets an incentivized performance target with consequences for their income. When a single in-clinic reading carries such weight, what exactly are we incentivizing?
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2849751
Each day in the US, more than 100 000 patients with hypertension are seen in office-based health care visits. A familiar scene at many of these visits begins with an initial blood pressure (BP) measurement of around 143/85 mm Hg, often measured on the way to the patient room, or immediately on entering and settling in for the visit. A repeat BP measurement, after conversation and cuff adjustment, reads 138/82 mm Hg. Clinically, this is routine variability. Administratively, however, it differentiates controlled from uncontrolled hypertension and may determine whether a clinician meets an incentivized performance target with consequences for their income. When a single in-clinic reading carries such weight, what exactly are we incentivizing?
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The Clinical Spectrum of Paroxysmal Atrioventricular Block
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2849749
To the Editor In a recent issue of JAMA Internal Medicine, Kawji presented an interesting case where premature atrial complexes triggered brief episodes of paroxysmal atrioventricular block (PAVB). The author provided a thorough explanation of the pathophysiology of bradycardia-dependent or phase 4 block. Kawji highlighted the importance of distinguishing phase 4 PAVB from vagally induced heart block. The former is characterized by the block being triggered by an abrupt lengthening of the P-P interval. Vagally mediated block, on the other hand, is characterized by gradual slowing of the sinus rate and atrioventricular conduction. Phase 4 block is an indication for pacemaker implantation, while pacing for vagally induced heart block is generally not warranted.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2849749
To the Editor In a recent issue of JAMA Internal Medicine, Kawji presented an interesting case where premature atrial complexes triggered brief episodes of paroxysmal atrioventricular block (PAVB). The author provided a thorough explanation of the pathophysiology of bradycardia-dependent or phase 4 block. Kawji highlighted the importance of distinguishing phase 4 PAVB from vagally induced heart block. The former is characterized by the block being triggered by an abrupt lengthening of the P-P interval. Vagally mediated block, on the other hand, is characterized by gradual slowing of the sinus rate and atrioventricular conduction. Phase 4 block is an indication for pacemaker implantation, while pacing for vagally induced heart block is generally not warranted.
The Clinical Spectrum of Paroxysmal Atrioventricular Block—Reply
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2849748
In Reply I want to thank Littmann for their thought-provoking comments about my recently published article. Phase 3 block is commonly encountered during periods of tachycardia or acceleration-dependent rhythms and usually affects the right bundle in particular, due to its longer refractory period. It is commonly seen during atrial fibrillation (Ashman phenomenon), sometimes with premature atrial contractions conducted with aberration, during rapid atrial pacing in electrophysiological studies, and indeed possibly with any fast supraventricular rhythm. Phase 3 aberrant ventricular conduction is primarily physiological, as discussed previously by Morton et al and others over the years. However, left bundle-branch block aberration during tachycardia suggests underlying conduction tissue disease. During tachycardia, the presence of diseased His bundle will usually result in progressive heart block, maybe culminating in complete heart block. The electrocardiogram (ECG) discussed in the second reference provided by Littmann shows 2:1, not complete heart block during tachycardia. The ECG in the fifth reference does not show the rhythm preceding complete heart block, so we cannot determine the mechanism. The third and fourth references do not address the main message in my article.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2849748
In Reply I want to thank Littmann for their thought-provoking comments about my recently published article. Phase 3 block is commonly encountered during periods of tachycardia or acceleration-dependent rhythms and usually affects the right bundle in particular, due to its longer refractory period. It is commonly seen during atrial fibrillation (Ashman phenomenon), sometimes with premature atrial contractions conducted with aberration, during rapid atrial pacing in electrophysiological studies, and indeed possibly with any fast supraventricular rhythm. Phase 3 aberrant ventricular conduction is primarily physiological, as discussed previously by Morton et al and others over the years. However, left bundle-branch block aberration during tachycardia suggests underlying conduction tissue disease. During tachycardia, the presence of diseased His bundle will usually result in progressive heart block, maybe culminating in complete heart block. The electrocardiogram (ECG) discussed in the second reference provided by Littmann shows 2:1, not complete heart block during tachycardia. The ECG in the fifth reference does not show the rhythm preceding complete heart block, so we cannot determine the mechanism. The third and fourth references do not address the main message in my article.
Decision and Cost-Effectiveness Analyses Complement Results From Randomized Clinical Trials
https://jamanetwork.com/journals/jama/fullarticle/2849648
Decision analysis is a quantitative approach to decision-making under conditions of uncertainty that uses explicit statistically based methods to compare alternative strategies based on their expected outcomes. Cost-effectiveness analysis is a form of decision analysis that compares resource use and health outcomes of competing strategies. The cost-effectiveness analysis by Lee et al in this issue of JAMA estimates that adding 1-time Helicobacter pylori stool antigen testing (HPSA) to fecal immunochemical testing (FIT)–based colorectal cancer screening programs could yield greater life-years and lower costs than FIT alone due to reductions in gastric cancer mortality.
https://jamanetwork.com/journals/jama/fullarticle/2849648
Decision analysis is a quantitative approach to decision-making under conditions of uncertainty that uses explicit statistically based methods to compare alternative strategies based on their expected outcomes. Cost-effectiveness analysis is a form of decision analysis that compares resource use and health outcomes of competing strategies. The cost-effectiveness analysis by Lee et al in this issue of JAMA estimates that adding 1-time Helicobacter pylori stool antigen testing (HPSA) to fecal immunochemical testing (FIT)–based colorectal cancer screening programs could yield greater life-years and lower costs than FIT alone due to reductions in gastric cancer mortality.
Blood Pressure Above Goal Among Adults With Hypertension in the US
https://jamanetwork.com/journals/jama/fullarticle/2849647
To the Editor We are dismayed by the number of US adults with uncontrolled blood pressure (BP), as reported in a recent Research Letter. We wish to bring additional attention to the current national quality performance measure target for high BP control of less than 140/90 mm Hg, which has been both outdated and stagnant since 2005. Since 2017, this measure has remained misaligned with national guidelines endorsed by the American Heart Association and the American College of Cardiology, which recommend control for adults with stage 2 and stage 1 confirmed high BP who are at increased risk for cardiovascular diseases (CVDs).
https://jamanetwork.com/journals/jama/fullarticle/2849647
To the Editor We are dismayed by the number of US adults with uncontrolled blood pressure (BP), as reported in a recent Research Letter. We wish to bring additional attention to the current national quality performance measure target for high BP control of less than 140/90 mm Hg, which has been both outdated and stagnant since 2005. Since 2017, this measure has remained misaligned with national guidelines endorsed by the American Heart Association and the American College of Cardiology, which recommend control for adults with stage 2 and stage 1 confirmed high BP who are at increased risk for cardiovascular diseases (CVDs).
Blood Pressure Above Goal Among Adults With Hypertension in the US—Reply
https://jamanetwork.com/journals/jama/fullarticle/2849646
In Reply We agree with Dr Casey and colleagues that the 2025 American Heart Association/American College of Cardiology (AHA/ACC) multisociety guideline’s BP goal of less than 130/80 mm Hg should be the national goal. We also agree that the previous BP goal of 140/90 mm Hg, which is included in many national quality metrics, is outdated and that the higher BP levels in quality performance measures may contribute to gaps between evidence and clinical practice. Estimates suggest that achieving and maintaining a BP goal of 130/80 mm Hg among US adults could prevent 500 000 more cardiovascular disease events nationally during 10 years compared with a goal of 140/90 mm Hg.
https://jamanetwork.com/journals/jama/fullarticle/2849646
In Reply We agree with Dr Casey and colleagues that the 2025 American Heart Association/American College of Cardiology (AHA/ACC) multisociety guideline’s BP goal of less than 130/80 mm Hg should be the national goal. We also agree that the previous BP goal of 140/90 mm Hg, which is included in many national quality metrics, is outdated and that the higher BP levels in quality performance measures may contribute to gaps between evidence and clinical practice. Estimates suggest that achieving and maintaining a BP goal of 130/80 mm Hg among US adults could prevent 500 000 more cardiovascular disease events nationally during 10 years compared with a goal of 140/90 mm Hg.
Cost-Effectiveness of Fecal Immunochemical Testing Alone vs Co-Testing With Helicobacter pylori Stool Antigen
https://jamanetwork.com/journals/jama/fullarticle/2849645
This cost-effectiveness analysis assesses the lifetime health benefits and costs of invitation to 1-time Helicobacter pylori stool antigen testing added to biennial fecal immunochemical test (FIT) screening compared with FIT alone.
https://jamanetwork.com/journals/jama/fullarticle/2849645
This cost-effectiveness analysis assesses the lifetime health benefits and costs of invitation to 1-time Helicobacter pylori stool antigen testing added to biennial fecal immunochemical test (FIT) screening compared with FIT alone.
Advertising in AI-Powered Clinical Decision Support Tools
https://jamanetwork.com/journals/jama/fullarticle/2849644
This Viewpoint discusses advertising in artificial intelligence (AI)–powered clinical decision support tools and stresses the importance of adopting and policing advertising policies with strong ethical guardrails within these tools.
https://jamanetwork.com/journals/jama/fullarticle/2849644
This Viewpoint discusses advertising in artificial intelligence (AI)–powered clinical decision support tools and stresses the importance of adopting and policing advertising policies with strong ethical guardrails within these tools.