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 ...

Panelists discuss how utilization management limits clinical autonomy and advocate for reforms that preserve shared, patient-centered decision-making. Panelists discuss how increasing utilization ...

NEWTON, Mass.--(BUSINESS WIRE)--The healthcare world is changing. And the new release of InterQual ® is all about helping you manage appropriate care through these changes. Available now, InterQual ...

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 ...

The healthcare industry is riddled with opportunities to automate clinical processes. Part of this opportunity stems from the growing prevalence of EHRs over the past decade. As of 2017, 80 percent of ...

Following a brief discussion on utilization management, experts discuss the current paradigm of patient access to therapy. Neil Minkoff, MD: Dr Stephens, could you also weigh in on how utilization ...

Utilization management policy has many forms, but has become increasingly complex as cancer scientific discovery has blossomed, cancer subtypes have become more numerous, therapeutic opportunities ...

LONDON--(BUSINESS WIRE)--Quantzig, a pure-play analytics solutions provider, has announced the completion of their latest big data analytics engagement on the health insurance marketplace. A leading ...

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 ...

The medical leader details how one payer practices utilization management. For our series The Exec, Dr. Cathy Moffitt — SVP and Aetna Chief Medical Officer at CVS Health — talked 21 st century ...

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-based healthcare review organization NYCHSRO/MedReview, Inc. has been granted URAC accreditation for its Independent Review (IRO) and Health Utilization Management (HUM) services. This press ...