As healthcare costs continue to rise and treatment options grow more complex, utilization review has become an essential part of managing care effectively. At Amalgamated Medical Care Management, utilization management services are designed to ensure that patients receive medically necessary care while helping payers control costs and maintain compliance. This balance is critical in today’s…

In today’s healthcare environment, employers, payers, and providers are all seeking ways to improve patient outcomes while managing rising costs. Medical case management is a proven solution that addresses both goals by coordinating care, reducing unnecessary services, and supporting patients throughout their health journeys. At Amalgamated Medical Care Management, our case management services are designed…

As health plan sponsors and payers seek more ways to meet the needs of their members, they are realizing the importance of personalized data. They are also realizing that case managers/care managers can and are playing a key role in meeting this goal, in addition to population health management objectives. Meeting Health Data Challenges Case…

On March 25, 1911, a devastating fire broke out on the top floors of the Triangle Shirtwaist Factory in New York City. In just 18 minutes, 146 garment workers, most of them young immigrant women, lost their lives. Locked exit doors, inadequate fire escapes, and unsafe working conditions made escape nearly impossible. This tragedy became…

Healthcare providers across the country are facing a growing crisis. Nurse burnout is reaching critical levels, largely due to high patient loads and persistent staffing shortages. A recent study found that nearly one-third of registered nurses are leaving the profession because of burnout, with many citing overwhelming workloads as the primary cause. This not only affects…

It has long been recognized that capturing valuable data and analyzing it can provide insights and opportunities across many areas, from improving the customer experience to increasing insurance coverage. LIMRA recently demonstrated how medical claims data is being leveraged to help market supplemental benefits. LIMRA surveyed insurance carriers and here is what the association learned….

Utilization management (UM) programs were put in place to facilitate clinically appropriate patient treatment plans and cost effective care. UM is used prior to pre-authorization during concurrent review and after a patient is discharged from a hospital or other clinical setting. As a result of the information gathered in UM, connections to disease management, care…

When introduced in 2015, the Medicare Chronic Care Management Program seemed to be a win-win-win for patients with chronic health conditions. The goal is simple: improve patient outcomes while reducing the cost of treatment. Under the program, the services include regular calls from physicians to monitor their Medicare patients, as well as: Patients who met…

When it comes to one’s overall health and well-being, it is not all about medical treatments, good nutrition and exercise. There are many other non-medical factors that contribute to an individual’s whole person well-being. These factors are known as social determinants of health (SDOH) and include one’s economic situation and job opportunities, housing opportunities, access…

Last year, in its Recover to Rebuild: Investing in the Nursing Workforce for Health System Effectiveness, the International Council of Nurses called for the worldwide shortage of nurses to be treated as a global health emergency. Currently, the United States is facing a national nursing crisis which is having a ripple effect across areas of…