Author: Vedant Bhosale

How to Build a Technology-First Strategy for UM Effective utilization management (UM) begins with a strategic approach grounded in technology, data, and continuous improvement. As AI adoption accelerates, payers must align their UM strategies with both regulatory demands and operational…

Health system executives are under growing pressure to manage tighter margins, navigate shifting reimbursement models and cultivate strong payer relationships. At the same time, unprecedented volumes of pricing data are becoming available, offering health systems a new source of insight…

Generative AI Pioneering the Future of Utilization Management The healthcare industry is rapidly positioning Generative AI (GenAI) at the forefront of Utilization Management (UM) reform. Far from being a speculative technology of the future, GenAI is here to transform stagnant…

During a featured session at Becker’s Spring Payer Issues Roundtable in April, leaders from Calm Health and behavioral health provider Magellan Health shared a blueprint for marrying clinical rigor with digital engagement to expand access to behavioral healthcare. Chris Mosunic,…

When medically complex patients require hospital care, they tend to experience longer recovery times than other patients do and are more likely to readmit to the ICU.1,2 Kindred Hospitals, a network of long-term acute care hospitals (LTACHs), is focused on…

During a featured panel discussion hosted by Kyruus Health at Becker’s Spring Payer Issues Roundtable, leaders from Highmark Health, Allegheny Health Network, Corewell Health and UCare came together to dissect one of healthcare’s quietest crises: provider data inaccuracy. The panel…

During a featured session at Becker’s 15th Annual Meeting, Jennifer Jones, clinical strategist at Noom Health, urged healthcare leaders to move beyond cost containment and consider how lifestyle interventions — particularly those incorporating GLP-1 medications — can transform clinical and…

The Urgent Need to Revamp Utilization Management Practices The healthcare industry is at a critical juncture, grappling with inefficient Utilization Management (UM) systems that have long been a source of frustration for patients, providers, and payers alike. Originally designed to…

As healthcare becomes increasingly data-driven, payers are turning to clinical health record data to strengthen claims processing, care coordination and risk management. This shift reflects a broader industry trend toward more integrated, real-time data use across the care continuum. With…

For payers, drug formulary development and maintenance are essential for accurate reporting and tracking of prescription medications. An up-to-date and well-established classification resource can help payers and other stakeholders manage their drug formulary more efficiently. While several classification resources are…