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…
Industry Challenge According to the recent Gartner report on “How Clinical Data Improves US Healthcare Payer Interoperability,” health plan leaders are counting on the integration of clinical data “locked in provider’s electronic health records” to enable a host of needed…
Artificial intelligence (AI) has dominated conversations among health plans and providers because of its potential to transform the industry. From predictive models for disease onset to chatbots answering member questions, the number of potential AI applications are innumerable. Yet, not…
Our country is facing a national mental health crisis. About half of the U.S. population will experience a major mental health issue during their lifetime, and approximately 20% of the population has a diagnosable mental health condition in any given…
Kindred Hospitals, a national network of long-term acute care hospitals (LTACHs), provide specialized treatment and rehabilitation for medically complex patients. LTACHs like Kindred are equipped to provide the same level of treatment as short-term acute care hospitals (STACHs) can but…
Executive Summary: Health plans must ensure network adequacy to meet regulatory requirements, maintain consumer trust, and provide a fulfilling member experience. However, network adequacy remains a fundamental challenge for plans due to inaccuracies in provider data. Health plans struggle with…
For health plans, the numbers are sobering: rising medical loss ratios, escalating healthcare costs, and increasingly complex patient needs are straining resources across the industry. Yet within this challenging landscape lies an overlooked opportunity for transformation: medication optimization.