{"id":1351,"date":"2024-09-25T13:58:58","date_gmt":"2024-09-25T13:58:58","guid":{"rendered":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-medical-care-management\/?p=1351"},"modified":"2024-09-25T13:58:59","modified_gmt":"2024-09-25T13:58:59","slug":"utilization-management-and-latest-reviews","status":"publish","type":"post","link":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-medical-care-management\/utilization-management-and-latest-reviews\/","title":{"rendered":"Utilization Management and Latest Reviews"},"content":{"rendered":"\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"676\" src=\"https:\/\/www.amalgamatedbenefits.com\/amalgamated-medical-care-management\/wp-content\/uploads\/sites\/2\/2024\/09\/medical-claims-data-1024x676.jpg\" alt=\"UM programs were put in place to facilitate treatment plans and care\" class=\"wp-image-1352\" srcset=\"https:\/\/www.amalgamatedbenefits.com\/amalgamated-medical-care-management\/wp-content\/uploads\/sites\/2\/2024\/09\/medical-claims-data-1024x676.jpg 1024w, https:\/\/www.amalgamatedbenefits.com\/amalgamated-medical-care-management\/wp-content\/uploads\/sites\/2\/2024\/09\/medical-claims-data-300x198.jpg 300w, https:\/\/www.amalgamatedbenefits.com\/amalgamated-medical-care-management\/wp-content\/uploads\/sites\/2\/2024\/09\/medical-claims-data-768x507.jpg 768w, https:\/\/www.amalgamatedbenefits.com\/amalgamated-medical-care-management\/wp-content\/uploads\/sites\/2\/2024\/09\/medical-claims-data.jpg 1114w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<p class=\"leading\">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 management, and population health program offerings can be linked to UM programs with collaboration between providers, payers and patients.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">How Health Plan Leaders Review UM<\/h2>\n\n\n\n<p>As reported by Medecision, less than 32% of health plan leaders rate their UM tools as \u201cvery effective\u201d at identifying health events in time to have a positive impact. An estimated 25% of health plan leaders said the UM tools are \u201ceasy to use\u201d. This data reflects that some regard UM programs as fragmented and challenging. In the February 25, 2024, webinar titled \u201cThe State of Utilization Management 2024,\u201d the top barriers to UM were discussed along with how healthcare leaders can address them. The expert speakers on the webinar were Julie Barnes, founder and CEO of Maverick Health Policy, Kenneth Young, President and CEO of Medecision, Stephanie Kovalick, Partner and CSO of Sage Growth Partners<\/p>\n\n\n\n<p>In the webinar, independent market researchers surveyed health plan leaders about the current state of UM. This research was examined along with what organizations need to do to transform UM and Care Management programs.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">The Findings<\/h2>\n\n\n\n<p>Among the important findings of the webinar and aforementioned UM data were the following:<\/p>\n\n\n\n<ul>\n<li>Over 50% of those surveyed point to fragmented data (57%), data that doesn\u2019t flow into UM workflows (55%) and burdensome data integration are the top barriers to current UM tools.<\/li>\n\n\n\n<li>68% say inefficient workflows are an organization\u2019s primary frustration with current UM tools, followed by high costs associated with data silos (49%) and provider abrasion (40%).<\/li>\n\n\n\n<li>Respondents say the current tools are not easy to use and they require technologies that are \u201cvery effective\u201d at accessing real-time data to drive down costs.<\/li>\n\n\n\n<li>The power of personalization in making UM more valuable by plan members and providers.<\/li>\n\n\n\n<li>How predictive modeling for risk stratification, as well as UM workflow optimization with AI and automation can propel UM efficiency, results and outcomes.<\/li>\n\n\n\n<li>What leaders should understand about regulations relative to UM including the newly-released prior authorization rule.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>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&#8230;<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[14],"tags":[],"acf":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-medical-care-management\/wp-json\/wp\/v2\/posts\/1351"}],"collection":[{"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-medical-care-management\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-medical-care-management\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-medical-care-management\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-medical-care-management\/wp-json\/wp\/v2\/comments?post=1351"}],"version-history":[{"count":4,"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-medical-care-management\/wp-json\/wp\/v2\/posts\/1351\/revisions"}],"predecessor-version":[{"id":1357,"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-medical-care-management\/wp-json\/wp\/v2\/posts\/1351\/revisions\/1357"}],"wp:attachment":[{"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-medical-care-management\/wp-json\/wp\/v2\/media?parent=1351"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-medical-care-management\/wp-json\/wp\/v2\/categories?post=1351"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.amalgamatedbenefits.com\/amalgamated-medical-care-management\/wp-json\/wp\/v2\/tags?post=1351"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}