It has long been recognized that capturing valuable data and analyzing it can provide insights and opportunities across many areas, from improving the customer experience to increasing insurance coverage. LIMRA recently demonstrated how medical claims data is being leveraged to help market supplemental benefits. LIMRA surveyed insurance carriers and here is what the association learned….

Healthcare providers across the country are facing a growing crisis. Nurse burnout is reaching critical levels, largely due to high patient loads and persistent staffing shortages. A recent study found that nearly one-third of registered nurses are leaving the profession because of burnout, with many citing overwhelming workloads as the primary cause. This not only affects…

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…

When introduced in 2015, the Medicare Chronic Care Management Program seemed to be a win-win-win for patients with chronic health conditions. The goal is simple: improve patient outcomes while reducing the cost of treatment. Under the program, the services include regular calls from physicians to monitor their Medicare patients, as well as: Patients who met…

When it comes to one’s overall health and well-being, it is not all about medical treatments, good nutrition and exercise. There are many other non-medical factors that contribute to an individual’s whole person well-being. These factors are known as social determinants of health (SDOH) and include one’s economic situation and job opportunities, housing opportunities, access…

Last year, in its Recover to Rebuild: Investing in the Nursing Workforce for Health System Effectiveness, the International Council of Nurses called for the worldwide shortage of nurses to be treated as a global health emergency. Currently, the United States is facing a national nursing crisis which is having a ripple effect across areas of…

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…