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 ...

Findings of a survey of large employers indicate that utilization management tools are ineffective in controlling health care costs for employees and may lead to barriers to treatment. Employer ...

Peoria, Ill.-based OSF HealthCare will use an AI-based and machine learning platform to streamline its utilization management services and improve workflows. The new platform, dubbed CORTEX, will help ...

Utilization management (UM) is a painstakingly manual process that adds administrative burden, increases healthcare waste and complicates payer-provider dynamics — yet does not necessarily improve ...

Every year, millions of dollars are lost to delays and inefficiencies in utilization management, making it one of the most daunting obstacles impeding timely, a ...

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 ...

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 ...

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 ...

Insurtech companies such as Oscar Health use technology to engage patients and offer risk-based, value-based care to engage providers in what is touted as a collaboration of savings, efficiency and ...

Benefit plan sponsors know they can rely on their brokers for many insurance products and voluntary benefits. Brokers, however, also have an opportunity to be even more of a resource to their clients ...