Healthcare in America is undergoing a major transformation, and in part, further prompted by the pandemic. We’re seeing many more consumers and healthcare providers use telehealth, as well as other technologies such as mobile apps to improve patient health literacy, treatment compliance and outcomes. Medical case management also continues to evolve as today’s latest trends…

Like many business processes, utilization management (UM) is being advanced by Artificial Intelligence (AI). The application of AI technology, as well as Machine Learning (ML), predictive analytics and real-time data, is driving a significant reduction in the time required to perform many administrative UM functions. Understanding how UM has evolved through technology and how today’s…

America’s 65 and older population is growing. According to the U.S. Census Bureau, there were 54 million seniors aged 65 and older living in America in 2020.  By 2035, it is projected that there will be 78 million American adults over age 65 and by 2040, this group is projected to grow to 78 million….

Across the nation, healthcare providers are experiencing unprecedented nursing shortages. Even before the pandemic, nursing shortages were evident with the COVID-19 pandemic only made the situation worse. There are several reasons for the shortages, but the prevailing one is the nurse-to-patient ratios which nurses are reeling against. Many are even striking to make a greater…

Physicians, nurses, and medical assistant shortages are at an all-time high. This problem has become so serious that even our elected officials are looking to develop bipartisan solutions to address the healthcare worker shortage. Definitive Healthcare reported that since 2020, one in every five healthcare workers has quit their job, and that by 2025, up…

On January 11, 2023, the U.S. Department of Health and Human Services (HHS) announced important dates upcoming in the first year of the Inflation Reduction Act’s Medicare Drug Price Negotiation Program. The program is expected to lower drug costs for millions of Americans by now giving Medicare the opportunity to negotiate prescription drug prices. The…

Currently, there is concern from many Independent Review Organizations (IROs) relating to state laws many believe may compromise the integrity of independent reviews. One association that has these concerns is the National Association of Independent Review Organizations (NAIRO). In a written statement from the organization, it noted that, “Within the health care ecosystem, independent peer…

While many industries faced unprecedented challenges over the past three years stemming from the pandemic, healthcare has perhaps felt the heaviest weight. Today, many of the obstacles healthcare has faced remain, and going into 2023, there will be additional challenges to manage. Here is a look at the top challenges healthcare providers will face in…

It has been ten years since the federal government began penalizing hospitals for what it deemed to be preventable readmissions under its Hospital Readmission Reduction Program (HRRP). The federal statute, Section 1886(q) of the Social Security Act, requires that the Secretary of the U.S. Department of Health and Human Services reduce payments to subsection (d)…

According to Data Bridge Market Research’s database, “Chronic Disease Management Market,” the chronic disease management market is expected to grow at a compound annual growth rate (CAGR) of 16.3% by 2029, to $20.64 billion. These diseases require long-term care and support to people with chronic conditions in terms of treatments, medications, and resources to manage…