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 ...

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 ...

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 ...

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 ...

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, ...

Bhavesh Shah, PharmD, and Robert Groves, MD, discuss the priorities payers should be taking into account when managing psoriasis treatment. Ryan Haumschild, PharmD, MS, MBA: Hello and welcome to this ...

RICHARDSON, Texas, December 08, 2025--(BUSINESS WIRE)--MedeAnalytics, an industry pioneer in AI-powered enterprise healthcare intelligence, analytics, and data management, and Basys.ai, an innovation ...

CMS began reimbursement for non–face-to-face chronic care management in 2015, and results from Louisiana show that it increases outpatient visits but decreases inpatient and emergency department ...

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 ...

Insurance companies often restrict University of Utah Health physicians from prescribing the optimal drug for a patient's illness. Providers are left to choose between the second or third choice after ...

Navitus, the nation’s first and largest transparent, pass-through pharmacy benefit manager (PBM), today announced the expanded implementation of Banjo Health. Banjo is an advanced automation platform ...