Findings of a survey of large employers indicate that utilization management tools are ineffective in controlling health care costs for employees and may lead to barriers to treatment. Employer ...

As healthcare costs continue to rise, businesses face increasing pressure to balance comprehensive benefits with financial sustainability. One of the most significant challenges is the escalating cost ...

Population health management is a perennial challenge for benefits leaders. If money were no object, a company could offer all manner of perks that might contribute to better health. But with ...

Panelists at an Academy of Managed Care Pharmacy (AMCP) Nexus 2022 session discussed enhanced utilization management strategies to manage the rising cost of specialty drugs, while providing members ...

Use of algorithms and artificial intelligence (AI) in prior authorization and utilization management is facing growing criticism and litigation. Notable lawsuits include alleged automatic ...

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 ...

How MCG Indicia software (enhanced with AI capabilities) has improved medical necessity documentation and increased hospital staff efficiency The sources of EHR data that are beneficial in determining ...

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 ...

MADISON, Wis.--(BUSINESS WIRE)--Navitus, the nation’s first and largest transparent, full pass-through pharmacy benefit manager (PBM), announced today it has achieved a series of accreditations and ...