The American Journal of Managed Care

Utilization Management Through Medical and Pharmacy Benefit

Assessing differences in utilization management between managing an IV product in terms of medical benefit vs. self-administered oral product in terms of pharmacy benefit. Transcript: Neil B. Minkoff, ...
The American Journal of Managed Care

Utilization Management in Women’s Health

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 ...
Fierce Healthcare

Study: Utilization management has ramped up in Part D over past decade

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, ...
Fierce Healthcare

Study: Drug utilization costs health industry $93B a year, with patients bearing most of the cost

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 ...
HealthLeaders Media

The Exec: How to Succeed in Utilization Management

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 ...
Becker's Hospital Review

8 Managed Care Contract Questions Regarding Utilization and Management

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 ...
Health Affairs

The Role Of Utilization Management: The Authors Reply

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 ...
Becker's Hospital Review

Optimizing Utilization Review with AI: Tackling Prior Authorizations and Concurrent Review

The administrative burden of utilization review processes like prior authorizations and concurrent review has long been a thorn in the side of healthcare providers. While prior authorizations have ...
JD Supra

California Limits Health Plan Use of AI in Utilization Management

California Governor Newsom signed Senate Bill 1120 into law, which is known as the Physicians Make Decisions Act. At a high level, the Act aims to safeguard patient access to treatments by mandating a ...
Business Wire

Sagility Introduces Utilization Management as a Service to Improve Prior Authorization, Mitigate Costs

DENVER--(BUSINESS WIRE)--Sagility, LLC, a technology-enabled healthcare business process management (BPM) company, has announced the launch of its Utilization Management as a Service (UMaaS) offering ...
Business Wire

NantHealth Achieves NCQA Accreditation in Utilization Management

WINTERVILLE, N.C.--(BUSINESS WIRE)--NantHealth, Inc. (NASDAQ-GS: NH), proudly announces that its Utilization Management Program has earned a 3-year reaccreditation from the National Committee for ...