Health systems and health insurance plans spend enormous sums of money battling over how to be paid fairly — and these battles have only intensified with the growth of Medicare Advantage plans, which ...
Utilization management in Medicare Part D has become more restrictive over the last decade, even when compared to Medicare Advantage prescription drug plans, according to a new study. The study, ...
Drug utilization management such as prior authorization and stricter formularies cost the healthcare industry $93 billion annually, with patients bearing the largest share of the cost, a new study ...
Jill O'Brien, Morton Hospital's new CMO, says the essence of utilization management is providing the right care for the right patient in the right setting at the right time. The new CMO of Morton ...
Panelists discuss how utilization management limits clinical autonomy and advocate for reforms that preserve shared, patient-centered decision-making. Panelists discuss how increasing utilization ...
GenHealth.ai and Guidehealth achieved up to a 60% reduction in Utilization Management workload using GenHealth’s AI-native platform, leading to $1.2M in annual savings. The system automates clinical ...
The administrative burden of utilization review processes like prior authorizations and concurrent review has long been a thorn in the side of healthcare providers. While prior authorizations have ...
On this episode of Managed Care Cast, we speak with the author of a study published in the November 2024 issue of The American Journal of Managed Care® to explore the link between utilization ...
Imagine an altogether different kind of utilization management that both payers and providers appreciate, where approvals are made at the point of decision, not after the fact. Utilization management ...
NEW YORK--(BUSINESS WIRE)--Today, VirtualHealth announced the release of a completely redesigned Utilization Management (UM) module within its cloud-based care management solution HELIOS®. The newly ...
Under30CEO on MSN
One size doesn’t fit all: Why oncology-specialized social work outperforms traditional case management
As value-based oncology expands, specialized social work is moving from “nice to have” to a measurable lever for adherence, ...
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