The Value of Utilization Management in Today’s Healthcare

The Centers for Disease Control and Prevention estimates that each year, the United States spends $41.3 billion on hospital readmissions. Many of the readmitted patients enter through  Emergency Departments (ED). According to the CDC, there are approximately 139 million ED visits annually with up to 37% of those deemed non-urgent. Reducing preventable hospital readmissions and…


Amalgamated Family of Companies’ Websites Have a Fresh, New Look

As the final phase of our rebranding initiative, the Amalgamated Family of Companies has updated the websites of its member companies. Upon visiting the new sites, you will see a fresh, new look that reflects more user-friendly navigation, functionality, and images.  You will see the increased use of icons, larger images, and larger font sizes….


The Importance of URAC Accreditation When Selecting a Medical Case Management Firm

For health care providers, as well as private and public employers, selecting the right case management firm when transitioning a patient from an inpatient setting to another level of care or determining when an employee can return to work is critical. While there are many organizations that provide case management services, not all have attained…


Advanced Technologies and Data-Driven Tools Enhancing Utilization Management

While there is no replacing the human component in effective healthcare utilization management, advanced technologies can deliver significant improvements. Artificial Intelligence (AI) used in combination with clinical evidence has been seen as one such technology.  Data-driven medication utilization management tools are another. AI in Utilization Management Leveraging AI, medical care managers and providers can process…


A Valuable Resource on Care Management for Primary Care Physicians

While care management is an integral component in patient care, there still remains a lack of real understanding as to its role and value. To help increase awareness, a comprehensive resource was developed, titled, Care Management – An Implementation Guide for Primary Care Physicians. The guide was produced with funding by the Agency for Healthcare…


Hospitals Still Experiencing High Readmissions

Data from Statista, which specializes in market and consumer data, demonstrates that many hospitals are still experiencing high rates of readmission. Statista found that as of Fiscal Year 2022 (FY2022), 2,920 hospitals have been penalized by Medicare at least once for hospital readmissions that exceeded the 30-day risk-standardized readmission rates. Furthermore, 1,288 were penalized for…


What to Expect in Employee Benefits in 2022

The past two years have been especially challenging for employers and employees. Both felt especially vulnerable under unprecedented conditions. There was widespread remote working, job losses, facility modifications, and an increased focus on employee benefits that offer vital protection at a time when it was most needed. The effects of the pandemic have promoted new…


Wellness Programs Matter Now More Than Ever

Oracle and Workplace Intelligence research found that 2020 was reported as the most stressful year experienced by working people. The research reported that 78% of workers surveyed indicated that the pandemic had negatively affected their mental health and 76% felt their employers should be doing more to protect employees’ mental health. And, in perhaps the…


Medical Case Management and the ROI

Most healthcare providers understand the role of medical case management, but some may still have difficulty quantifying the financial value of these services. A study reported on by the National Library of Medicine on the https://pubmed.ncb.nlm.nih.gov website found that Medicare patients who received patient-centered care transition intervention had significantly lower healthcare utilization in the six…


Increasing Demand for Medical Case Management Services

A recent study released by Coherent Market Insights confirms that medical case management services are in high demand driving the industry’s growth. According to the study, the global medical case management services market size is expected to experience a projected compound annual growth rate (CAGR) of 3.3% by 2027 with revenues topping $6.2M.  There were…