To better understand the Medicaid managed care market during a period of rapid change, we developed a new data set that links Medicaid enrollment data with health maintenance organization (HMO) industry data for 1993-1996 to analyze Medicaid enrollment in full-risk health plans. Nearly half of the Medicaid enrollees in a fully capitated managed care arrangement were in plans in which Medicaid makes up at least 75 percent of the total enrollment. In addition, the number of Medicaid-only plans has more than doubled since 1993. Commercial-based plans participated increasingly in Medicaid managed care during the period, yet more than half of the plans entering the Medicaid market were newly formed. T HE RECENT GROWTH in Medicaidmanaged care has dramatically changed the way Medicaid beneficiaries in many states obtain health care. In 1996, 7.7 million Medicaid beneficiaries (23 percent of all Medicaid beneficiaries) received care under fully capitated Medicaid managed care programs in thirty-five states, compared with 2.6 million beneficiaries in 1993. This change suggests a need to track the types of health plans in which beneficiaries are enrolling, to better understand the changing health care market, and to identify any policy implications. The changes of interest include changes in participation by commercial-based plans, the rate at which new health plans are forming to serve Medicaid, the extent to which patterns and changes vary by region or state, and the role of health plans that are Medicaid-only or Medicaid-dominated relative to other plans. In this paper we address these issues using a new data set that we developed specifically for this purpose.Tracking full-risk health plans serving Medicaid is important for policymakers because these are the plans that face the strong financial incentives to reduce service use that are inherent in fully capitated payment. Lack of adequate oversight for such plans can result in problems such as possible instances of underservice or inadequate documentation. Further, shifts over time in participation by these plans create a changing landscape for consumers who are navigating a Medicaid program that presents them with more choices than in the past.Overall, we found that the number and proportion of plans serving Medicaid beneficiaries grew dramatically between 1993 and 1996, although the size and other characteristics of the plans remained relatively stable. Commercial plans' participation increased substantially over the period, yet more than half of the new plans entering the Medicaid market were newly formed plans, and most of these were Medicaid-only plans. There are now at least 144 Medicaid-only plans, and by June 1996,3.6 million Medicaid beneficiaries were enrolled in plans in which Medicaid enrollees comprised at least 75 percent of the total enrollment. We therefore suggest that more atten-

BackgroundWhile use of total thyroidectomy has increased in management of hyperthyroidism, concerns exist about increased surgical complication rates; most notably, hematoma, recurrent laryngeal nerve (RLN) injury, and hypocalcemia.MethodsRetrospective cohort study of 454 patients undergoing total thyroidectomy between 2003 and 2015. All patients had surgery for hyperthyroidism, benign euthyroid disease, or thyroid malignancy.ResultsTotal thyroidectomy for hyperthyroidism was not associated with an increased risk for any postoperative complication. Transient hypocalcemia, temporary dysphonia, and postoperative hematoma rates were not significantly different for patients with hyperthyroid (n = 91), euthyroid benign (n = 237), and malignant (n = 126) disease. Permanent hypocalcemia and recurrent laryngeal nerve injury were not noted in any hyperthyroid patients. Complication rates were similar for hyperthyroid patients with Graves' disease vs toxic multinodular goiter.ConclusionThis study affirms safety and efficacy of total thyroidectomy as standard treatment for hyperthyroidism.

We describe a 43-year old patient with Covid-19 who developed a bullous hemorrhagic rash that progressed to necrotic lesions. Histopathology confirmed a vasculitis of small and medium-sized cutaneous vessels.

Solitary median maxillary central incisor (SMMCI) coexists in 34%-65% of patients initially diagnosed with congenital nasal pyriform aperture stenosis. SMMCI, a genetic syndrome, warrants consideration for further screening because of its high prevalence of other diagnostic possibilities—specifically central defects, like nasal obstruction and hypothalamo-pituitary axis abnormalities. We report on a presentation of SMMCI with congenital nasal pyriform aperture stenosis which highlights the unique radiologic features and notes the relationship between these two central associated findings in the literature.