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, ...
Smart Business Magazine

Integrating utilization and case management for optimal results

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 ...
Becker's Hospital Review

Why utilization management matters

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 ...
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 ...
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 ...
The American Journal of Managed Care

Impact of Utilization Management on Physician Autonomy and Shared Decision-Making in Oncology

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

New Century Health Achieves NCQA Accreditation in Utilization Management

BREA, Calif.--(BUSINESS WIRE)--NCH Management Systems, Inc., D/B/A New Century Health (NCH), a national leader in specialty care management, today announced it has been accredited in Utilization ...
HealthLeaders Media

The Exec: CMO Dr. Cathy Moffitt Talks UM at Aetna

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 ...
The American Journal of Managed Care

Association of Care Management Intensity With Healthcare Utilization in an All-Condition Care Management Program

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 ...
The Caledonian-Record

Healthcare Payer IT in 2026: Digital Prior Authorization, Enforceable Transparency, and Outcomes-Driven Platforms Spark a New Acquisition Race

CMS compliance deadlines and heightened cybersecurity expectations are accelerating payer interoperability and utilization ...
Becker's Hospital Review

How automating medical necessity can improve utilization management

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 ...
Forbes

Resource Utilization: Definition, Formulas And Examples

Monique Danao is a highly experienced journalist, editor, and copywriter with an extensive background in B2B SaaS technology. Her work has been published in Forbes Advisor, Decential, Canva, 99Designs ...