How can health systems deliver the right care, at the right cost, in the right setting, without overwhelming delivery and reimbursement systems with administrative burden? The shift from volume to ...

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 ...

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, ...

Utilization management began as a way for health care organizations and professionals to evaluate the effectiveness and efficiency of the services they provide to patients. The approach has grown and ...

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 ...

Medical management programs are typically comprised of multiple services designed to help control health care costs and ensure optimal health outcomes for employees. “While these sorts of programs can ...

U.S. Drug Utilization Management Market · GlobeNewswire Inc. Dublin, Aug. 19, 2024 (GLOBE NEWSWIRE) -- The "U.S. Drug Utilization Management Market Size, Share & Trends Analysis Report by Program Type ...

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 ...

TAMPA, FL / ACCESS Newswire / June 1, 2025 / Amid escalating regulatory requirements, increasing cost pressures, and rising consumer expectations, Black Book Research today announced the top-rated ...

While utilization management in general is a pain point for everyone, it’s a necessary evil in the United States, where we spend 18% of our gross domestic product on healthcare, explained Debra Patt, ...