Healthcare Business Review Weekly Brief
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Healthcare utilization management is constantly evolving due to advancing technology and the intent to improve patient care and adherence to medications while reducing costs for all stakeholders. With an industry full of opportunities and challenges, knowing how and when to identify and act on them is crucial to optimizing outcomes.
Arguably, one of the most significant advancements in utilization management is the ability to use real-time healthcare data analytics that provide a daily update of changes in the market. Benefits managers can construct and review reports that allow them to identify opportunities immediately and take action quickly.
The addition of physician advisors and clinical documentation improvement (CDI) specialists to the healthcare utilization review process has also resulted in significant performance gains. The inclusion of doctors in case management teams helps to accurately assess medical necessity because they offer insightful clinical judgment.
To put the spotlight on such key developments in the industry, Healthcare Business Review illustrates how the healthcare utilization management space is leveraging new trends like predictive analytics and CDI specialists.
This edition also features thought leadership articles from subject matter experts. Some of the exclusive insights are authored by Jennifer Mulligan, LCSW, Director of Behavioral Health Utilization Management, MetroPlusHealth; and Maryanne Bourque, Director, Utilization Management, Nurse Case Management, and Complex Scheduling, at Nemours. They shed light on managed care organizations (MCOs) that are contracted to provide administrative support as well as assist healthcare officials in meeting necessary health maintenance standards, disease management, and overall coordination of care.
In this edition of Healthcare Business Review, we also bring to you the story of the top healthcare analytics solution providers. In the list, Health Network One stands out for offering its expertise in Physical, occupational, and speech therapy; dermatology; vision and ophthalmology; podiatry; and gastroenterology and urology. Equally commendable is the story of Monroe Plan for Medical Care, which offers medical and behavioral health and reviews pre-service, concurrent, and post-services for all service categories
Through the following pages, we aim to shine a light on the innovative trends and latest developments in the healthcare utilization management industry. We would like to know your thoughts.
Usually, the qualified subscribers of our magazine nominate companies with whom they have collaborated and experienced exceptional results to be in this list. Did a company you recently worked with give you stellar results and ROI? Did it turn out to be one you would wholeheartedly recommend to peers? Or do you know of such an outstanding company through your network? Please fill in the details below and nominate them to be featured here.
For over 50 years, Monroe Plan for Medical Care, a not-for-profit health care services organization, has been focused on improving the health status of individuals and families who are recipients of government sponsored health insurance. Monroe Plan is the parent company of MP CareSolutions, a Healthcare Management Services Subsidiary, offering expertise in Population Health Management, Care Management, Utilization Management, Value Based Analytics, Provider Network Operations and Contracting.
Health Network One is the leader in specialty network management, with expertise in several disciplines, including outpatient therapy, ophthalmology, dermatology, and podiatry. Covering more than 5,000,000 lives, the company manages the entire value chain under full risk, and deliver benefits far beyond significant and guaranteed cost savings.
Dr. Mary McCluskey, Chief Medical Officer and Adam Kustin, VP of Marketing & Business DevelopmentWe are a category of one
Health Network One
Management
Dr. Mary McCluskey, Chief Medical Officer and Adam Kustin, VP of Marketing & Business Development
Allscripts is a pioneer in providing healthcare information technology solutions that increase clinical, financial, and operational outcomes. Our cuttingedge solutions link people, places, and data across an Open, Connected Community of HealthTM. Connectivity enables caregivers to make more informed decisions and provide better care to healthier populations
Appian is a single change platform that allows previous authorizations and ensures clinical consistency on a low-code platform that simplifies approvals. With Appian, organizations can decrease manual, one-time approvals for speedier consent and provider reimbursement, resulting in greater provider and internal staff satisfaction and also helping to enhance member outcomes
Change Healthcare assists payers, providers, and patients in improving clinical and financial results, allowing everyone in the healthcare system to thrive. The Change Healthcare Platform offers industry-leading analytics, vast data, and unrivaled connectivity and data transfer across providers, payers, and consumers to enhance workflows, administrative and financial efficiency, and clinical choices
Conduent is a dependable partner for healthcare companies, collaborating with all stakeholders to increase engagement, collaboration, insights, and outcomes. They understand the regulatory and competitive difficulties that healthcare companies confront and the economics of each industrial sector. They, therefore, collaborate with their customers to enhance performance and results
Epic Systems is a healthcare-focused software firm that creates and sells technologies that help people improve their health. Community hospitals, academic medical facilities, children's organizations, safety net providers, retail clinics, multispecialty groups, integrated delivery networks, rehab centers, and patients' homes, among other places, employ the company's goods
With 22 years of expertise covering 39 states and 30 million people, i2i is the nation's biggest population health technology firm servicing the underserved safety net sector. The i2i platform is the driving force behind a sophisticated data integration & aggregation engine that distributes standardized clinical and administrative data via proprietary quality management and care coordination apps
With 50 years of managed care expertise, businesses can trust that MP CareSolutions understands how difficult it is to balance patient care, medical expenditures, and regulatory obligations. They integrate knowledge with an awareness of the need to build and implement UM programs that are appropriate for the business, with timeliness, compliance, and efficiency at the forefront
Optum is a major information and technologyenabled health services company devoted to improving the healthcare system for everyone. Optum employs over 190,000 people globally and provides innovative, integrated solutions that modernize the health system and enhance public health
