Value-based care requires collaboration between payers and providers to ensure the patient receives the most appropriate care in the most appropriate setting. However, the current utilization ...

Panelists discuss how increasing utilization management oversight affects physician autonomy and the shared decision-making ...

Health plan leaders uphold responsible guardrails that enable affordable and quality care. However, with the rising cost of healthcare in the United States, this can be challenging. Two essential ...

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 ...

For years, delegating utilization management (UM) functions to third-party vendors was seen as a practical response to rising medical costs, regulatory complexity, and distributed networks. Vendors ...

Scott Howell ([email protected]) is the chief strategy officer, US Pharmaceuticals, at Novartis Pharmaceuticals Corporation, in East Hanover, New Jersey. Perry T. Yin is the director of Market Access ...

FRISCO, Texas--(BUSINESS WIRE)--Magellan Healthcare Inc., the behavioral healthcare segment of Magellan Health, Inc., today announced that it has earned full URAC accreditation for Health Utilization ...

TYSONS, Va.--(BUSINESS WIRE)--Maximus, a leading employer and provider of government services worldwide, today announced it has again earned URAC full accreditation for Health Utilization Management ...

The Los Angeles County Medical Association and two patients have filed a lawsuit against Health Net of California (PDF), accusing the insurance company of implementing "a defective utilization ...