As hospitals and health systems continue to grapple with revenue leakage and clinical denials, many are turning to innovative technologies to bridge the gap between payers and providers. Organizations ...

Utilization management involves methods by health care plan administrators to minimize costs while also maintaining the quality of care. The process is intended to prevent wasteful spending but not to ...

Higher intensity of care management in an all-condition program addressing care coordination and care barriers was associated with increased healthcare utilization among Medicaid and Medicare patients ...

Yet there is positive momentum building against these trends as healthcare organizations look to reinvigorate many value-based care avenues like utilization management. Defined as the group of ...

The MarketWatch News Department was not involved in the creation of this content. GenHealth.ai and Guidehealth achieved up to a 60% reduction in Utilization Management workload using GenHealth's ...

“Many employers and their health plan members assume that a utilization management program’s only goal is to approve or deny medical procedures and save costs for the health plan. In reality, ...

Utilization management has the power to perform many jobs. Will it? Well before the Affordable Care Act, CMS defined the highest aim of utilization management: Value. In its 1991 UM study, the agency ...

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 ...

We appreciate the thoughtful response of Susan Cantrell and the Academy of Managed Care Pharmacy to our work (August 2021). Our study highlights the burden of drug utilization management on the ...

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 ...

This survey assesses physician experiences with utilization management and burnout and investigates whether there is a link between them. Objective: This study was designed to assess physician ...