With the New Year upon us, we felt this to be an appropriate time to communicate our New Year's resolutions for The American Journal of Managed Care (AJMC). In our introductory September editorial, we announced our goals to elevate the quality of the research, devote more pages to health policy issues, and publish articles that are increasingly relevant to our readers. As we have settled into the Editor's role, we have only become more convinced of that strategic vision. With this, we'd like to present the plans - which are concentrated in 4 main areas - that will help us to achieve these goals.

First, it is our hope and expectation that a revamped approach toward the solicitation, classification, and review of manuscripts will encourage manuscript submissions from an ever-enlarging group of authors and ultimately attract new readers. To provide direction and assistance, we substantially altered the make-up of our editorial board (please take a look at page 8) such that it mirrors your broad interests and expertise. We have also launched programs to establish a dialogue with our readers, particularly those not working in academic settings, who translate our research findings into practice. Lastly, we felt it worthwhile to express our views on the Journal's business strategy; since we learned instantly after accepting this position that success in the financial arena is required if we are to achieve our mission.

At the end of the day, we feel strongly that the manuscripts we publish will determine our level of success. After a careful assessment of this publication's history, we believe that a clear message regarding the types of manuscripts that are "right" for the Journal has been lacking. Past issues used numerous (and sometimes inconsistent) subject headings to categorize the articles. After considerable thought, we decided upon a broader, more stable, classification scheme. As can be seen from this month's Table of Contents, original research articles are now categorized into 4 categories: Clinical, Managerial, Policy, and Methods. Although it may be a challenge to place certain articles in one category (and others may reasonably be placed in more than one), we feel that this system will assist authors in their submissions and streamline the editorial process. The Journal's Information for Authors has been changed to reflect these and other changes. (Please see page 82.)

The Clinical category includes manuscripts that examine the health and/or economic impact of specific medical interventions. The merit of clinical manuscripts is judged on the significance of the clinical question, the strength of the study design, and the potential impact of the results on clinicians' practice or health plan policies. We are not of the opinion that the only acceptable study design for clinical articles is a randomized trial. We encourage the submission of studies that use other established methodologies, such as observational studies, decision analysis, and meta-analyses. For example, we hope to continue to attract high-quality studies that use computer simulation methods. Given the hypothesis-generating value (instead of hypothesis testing) of decision analysis, we would like to emphasize the importance of highlighting sensitivity analyses when uncertainly exists regarding the value of certain model inputs. We feel that in many cases the results of sensitivity analyses are more meaningful to decision makers than the base case results. Although rare exceptions may exist, we strongly recommend that papers submitted to this category compare the effect of an intervention to available alternatives (eg, avoid placebo comparators when other treatments are available). Such studies are increasingly desirable relative to purely descriptive papers that report outcomes attributable to one clinical strategy. The use of such comparative studies by managed care organizations, pharmacy benefit managers, and others has grown rapidly over the past few years and should only continue into the future.

Manuscripts in the Managerial category address the clinical or economic impact associated with managerial interventions implemented by clinicians or health plans to alter the care delivery process. These include a wide range of studies such as those examining the influence of changes in benefit design, referral rules, formulary requirements, reimbursement policy, and disease management programs on the quality and cost of care. Studies may report empirical results or provide conceptual analyses of issues relevant to managerial interventions or health plan design. As with the clinical manuscripts, our evaluation will focus on the importance of the issue and credibility of the findings, which depend on the quality of the research design and analysis. Several of the most influential AJMC manuscripts published to date fall into this category. It is our hope that we continue to be a leading forum to publish rigorous evaluations of interventions aimed to improve the quality of clinical care or promote the efficient use of healthcare resources.

Policy articles address the influence of the regulatory environment on the quality, delivery and financing of healthcare. Manuscripts that assess statutes such as the Employee Retirement Income Security Act or the Health Insurance Portability and Accountability Act would fit into this category, as would papers that inform policy issues such as analysis of potential Medicare prescription drug benefit plans, Food and Drug Administration regulation and behavior, or the recommendation for a national smallpox vaccination program. These articles might also provide analysis of managed care topics in a context relevant to policy makers, such as determinants of healthcare cost growth or the impact of managed care penetration on clinical outcomes. It is our opinion that a much-needed dialogue between clinical decision makers and policy makers has not been adequately established. Thus, we intend to focus more attention to the policy arena, particularly as it impacts the day-to-day practice of clinical medicine.

The Methods category is comprised of papers that introduce innovative methodological approaches or describe advances to existing health services research techniques. We expect submissions in this area to report on topics such as quality of life assessment, risk-adjustment methods, or approaches to measure health plan quality. Advances in quantifying resource utilization, such as accounting for lost worker productivity, would also be welcome. Since we are not inclined to publish highly technical articles, papers in this category must be written in a straightforward style that would be viewed as relevant by our readers.

With this outline loosely describing the types of articles we are looking for, it is also worth pointing out the types of articles that we are less inclined to publish. Studies that simply report the clinical and/or economic ramifications of a specific disease (ie, a "burden of illness" study) are of minimal interest to us, unless they convincingly discuss how an intervention may directly impact the burden. Our lukewarm attitude extends to studies that examine a specific treatment using a "before and after" design and that do not include a meaningful comparator or control group.

Peer Review
Since moving from our roles as board members and occasional contributors to Co-Editors-in-Chief, we have rapidly become familiar with the editorial process from the "other side." We have implemented a peer review process that takes advantage of our different backgrounds, and perhaps more importantly, emphasizes our commitment to publishing papers highly relevant to our readers. Consistent with our new classification system, Mark will take responsibility in overseeing the Clinical submissions and Mike will oversee papers that fall into the other 3 categories. Upon submission, each manuscript is assessed by one of us, the editorial staff, and/or an editorial board member to determine whether the content is appropriate for the AJMC readership. Once a paper passes this initial step, 3 additional reviewers will be selected. As a general rule, 2 reviewers will be chosen to evaluate the methodological rigor and technical quality of the manuscript. We recently implemented a system where we include a third reviewer to explicitly evaluate the relevance of the article for the AJMC readership. Thus, to be accepted for publication, manuscripts must pass both hurdles, technical quality and relevance. In managing this process we will strive to maintain an expedited turn-around time for reviews (4-6 weeks).

Editorial Board 
Another major change that we believe will facilitate the AJMC's new direction has been made among the editorial board. We have added 22 individuals (and will continue this expansion in the months ahead), going to great lengths to reach out beyond the ivory towers of academia—to the healthcare management sector, to research groups within managed care plans, and to the health policy community. We have structured the board to include clinicians, health services researchers, and decision makers, and it is our expectation that with their dedication and hard work our aims will be achieved. In addition to their oversight, we have charged to our editorial board members to identify potential authors and assist us in the peer review process.

Further Outreach
Our expanded Editorial Board is one of many initiatives currently under way to expand both our author and readership base. We will continue to strive to reach key clinical decision-makers—a key component of the founding mission of the AJMC. We believe that we offer contributors unparalleled access to more than 50 000 members of this important community. We offer reduced subscription rates in specific circumstances (eg, students), and are in the process of making the AJMC available in every library in schools of medicine, public health, pharmacy, and nursing. We intend to make every effort to increase our presence in the research settings, both inside and outside of academic institutions. We will rededicate our efforts to provide continuing education for our clinical readers, offering medical education through a new partnership with the University of Pennsylvania and pharmacy education through the University of Tennessee.

As ever, we remain keenly interested in hearing from our readers. We are in the process of creating an Advisory Board—independent of the Editorial Board—composed largely of readers from non-academic settings who are charged to counsel us regarding journal direction and content. In fact many of you may have already received (and hopefully returned, thank you) surveys aimed to measure what our readers like and dislike most about the AJMC. We welcome motivated individuals to contact us if interested in playing a role in this endeavor. Lastly, we intend to regularly publish invited expert commentary on relevant but potentially controversial topics in an attempt to stimulate discussion via our Letters to the Editor Section.

Over the past few months, we have been exposed to a "crash course" in Publishing 101. The most important takeaway message is crystal clear: no matter how successful we are in publishing relevant, high-quality articles, a sound business plan is essential to sustain the Journal. As with many healthcare journals, a substantial amount of our fiscal support is provided by advertising and supplemental issues. Given our current distribution pattern, the Journal could not continue without these activities. In light of this, we want you to know that the editorial and marketing activities of AJMC are completely separate. No individual involved in the editorial process knows how any given editorial decision will affect the Journal's business activities. Likewise, all editorial decisions are and will remain apart from the business side of the publication.

Supplemental issues of AJMC provide the Journal with significant revenue. Guidelines for supplements that aim to minimize bias and stress full disclosure are in place and are published in each supplement. Like all editors in the healthcare field, we are concerned about biases in the studies induced by industry funding. Similar to other journals that adhere to the Uniform Requirements for Manuscripts Submitted to Biomedical Journals, we require full disclosure of conflict of interest of all authors and detailed information regarding funding of submitted research. The articles in the supplements are peer-reviewed under the supervision of a guest editor chosen by the sponsor of the activity.

As part of our efforts to expand our content, we will continue to publish "Special Issues" that will allow us to address relevant topics in more depth. Papers published in special issues will undergo the same peer-review process as manuscripts published in the regular issues of AJMC. Special issues differ from the regular issues only in that they require separate funding. We feel that if we choose the topic correctly, these special issues will provide an attractive mechanism for the research and policy community to reach a wide spectrum of interested readers.

We have laid out an ambitious agenda for the coming year. We ask for your support and counsel to help keep us on our intended path. Please let us know your thoughts on our proposed direction and if you are motivated to do so, help us to attain the high expectations we have set for The American Journal of Managed Care.

 

May the New Year bring good health, happiness, and success.