By meeting these standards, ProPeer demonstrates that its utilization management program operates with transparency, clinical rigor, and accountability, providing clients with confidence that reviews ...

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 ...

A medical professional explains the many facets of the prior authorizations process for drugs in women’s health. Ryan Haumschild, PharmD, MBA, MS: Prior authorizations are something that we’re used to ...

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, ...

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

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 ...

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 ...

8 Managed Care Contract Questions Regarding Utilization and Management Naya Kehayes, managing principal and CEO of Eveia Health Consulting and Management, recommends hospitals and other providers ask ...

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 ...

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 ...

As value-based oncology expands, specialized social work is moving from “nice to have” to a measurable lever for adherence, utilization, and patient experience. When cancer treatment goes off track, ...