Archive | Workers’ Compensation & Utilization Management

How Privatization Affects Workers’ Compensation Programs

WC claims impact state budgets depending upon the structure of programs within each given state.

Privatization has emerged as one solution to curb the costs of workers’ compensation on state funds.

Workers’ Compensation Reforms: What’s on the Horizon?

WC reforms are popping up around the nation.

The high variance of WC rules and regulations by state makes it difficult to generalize about future trends.

An Overview of Evidence-based Medicine

Evidence-based medicine considers additional testing and trial models.

The gold standard for evidence for EBM – randomized controlled trials (RCTs) – only emerged in the 20th century.

When and Where Air Ambulances Save Lives: Part 2 of a 2-part series

Air ambulances provide quick transportation for patients in remote locations, as well as for paramedics and other medical professionals whose services can be the difference between life and death in an emergency. In the first part of this series, we looked at why hospitals offer air medical services (AMS) and how insurers and patients navigate […]

The Rise of Air Ambulance Use: Part 1 of a 2-part series

Air ambulances have rapidly become vital and unique fixtures of the U.S. healthcare system. As specialized aircrafts – i.e., medically equipped helicopters and fixed-wing airplanes – they provide emergency transportation over distances and/or terrains that would be impractical for ground ambulances.   Their use has surged since 1980, when medical helicopters began to be manufactured […]

5 Unique Benefits of the Patient-Centered Medical Home

“Patient-centered” is a widely used term in health care discussions, but what does it really mean? The patient-centered medical home (PCMH) provides an instructive example. A PCMH embodies an approach to the primary care practice (PCP), one in which care is coordinated, accountable and comprehensive, as well as inclusive of wellness, preventive, acute and chronic […]

Value-Based Reimbursement and Improving Quality of Care

Making an effective transition to value-based care, and to a corresponding reimbursement model that works for medical providers, insurers and patients alike, is a longstanding goal for much of the U.S. healthcare system. There are many compelling reasons for adopting value-based reimbursement (VBR) as a replacement for traditional fee-for-service (FFS), with two of the most notable […]

A Look Back at 100 Years of Behavioral Health

For centuries, healthcare providers have offered behavioral health treatments for a variety of mental and physical conditions. Today, we often equate behavioral health only with mental health, but the term is broader than that, both historically and at the moment. It may also encompass any treatment for behavior-affected conditions such as hypertension, prediabetes and substance […]

How Workplaces Can Lower Insurance Costs

A healthy workforce is vital to a thriving business. Beyond keeping premiums affordable and basic healthcare accessible, today’s employers are facing several challenges to controlling the cost of health insurance: The U.S. Bureau of Labor Statistics estimated that inflation for medical care in American cities fluctuated between approximately 2 percent and 5 percent (in terms […]

The Life of a Group Health Case [Infographic]

Wondering where an IRO fits into the external review process? How about whether an RN versus an MD can approve or deny a case? Check out our infographic on The Life of a Group Health Case to learn about physician-level reviews and the role of an IRO in Group Health plans!

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