Medical case managers fulfill a vital role in today’s healthcare. They serve as the connectors between their patients, other members of the patient’s clinical team, and various other healthcare and community resources. While the need for case managers continues to grow due to such factors as our nation’s aging population, the increase in various complex,…

Since their introduction in the late 1960s, pharmaceutical companies along with insurers and pharmacists all played a role in pharmacy benefit management. Their involvement ranged from drug pricing negotiations and distribution to managing formularies and developing a network of insurance covered pharmacists. Today, PBMs have assumed a role in which they align payers to negotiate…

Navigating today’s evolving healthcare landscape is challenging for any industry but especially for healthcare administrators charged with overseeing the delivery of quality patient care, complying with numerous regulations, and supporting their institutions’ fiscal performance. This balancing act demands that they stay abreast of the latest healthcare trends. Here are some of the latest trends as…

In its “2024 Healthcare Trends and Insights,” Vital WorkLife sheds some light on how our nation’s healthcare professionals are doing in terms of their relationship with themselves and their loved ones, their work, and community. The findings reveal the continued stress on healthcare professionals in our post-pandemic period and what measures are helping them achieve…

While it is not making headlines like it was during the pandemic and directly after, the nursing shortage in the United States continues to persist. The U.S. Bureau of Labor Statistics projected that an additional 275,000 nurses would be needed over the period from 2020 to 2030. The American Hospital Association projected that a million…

Recently, the Centers for Medicare and Medicaid Services (CMS) released data which showed how it is cutting reimbursement rates for hospitals based on their performance relating to surgical site and bacterial infections and hospital readmissions. The goal of CMS is to raise the quality of patient care. Under the Hospital Readmissions Reduction Program parameters, hospitals…

An event 113 years ago would change the lives of factory workers forever. It was March 25, 1911 and the location was downtown Manhattan; specifically, the Triangle Shirtwaist factory located in Greenwich Village. It was there on that date that the deadliest industrial fire occurred in the history of New York City. In total, 146…

On March 25, 1911, a horrific factory fire claimed the lives of 146 workers at the Triangle Shirtwaist factory in New York City. Those lost included 123 women and girls as young as 14 years old, as well as 23 men.  They were earning between $7 and $12 for a 52-hour work week. The lives…

When used appropriately, telephonic case management can be extremely beneficial for patients. Numerous studies have documented its value in improving patient outcomes, decreasing preventable hospital readmissions, avoiding lengthy disability periods, and lowering healthcare costs. Knowing when early intervention for telephonic case management is warranted is the first step in achieving these goals. When Telephonic Case…

The U.S. healthcare utilization management industry is projected to reach $9.5 billion by 2028, but the industry will see some developments. (Source; Market Research.com, National Association of Insurance Commissioners). These include the heightened role of data, increased emphasis on patient engagement, and a greater focus on value-based care, which has long been a focus of…