Archive | Utilization Management

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!

An Update on the Opioid Crisis

The opioid crisis continues to loom in healthcare, as more individuals become addicted to and die from lawful and illegal forms of opioids. While controlled substances such as heroin are to blame for much of the problem, prescription medications are also a contributor. Variation in how physicians treat chronic pain and non-nerve-related back pain and […]

Quick Reference Guide to Drug Utilization Reviews [Infographic]

The 21st Century Cures Act, the opioid crisis, and the cost of pharmaceuticals dominated the headlines of 2016, highlighting the importance of understanding how prescription drugs work in today’s healthcare industry. One valuable tool used by employers, health plans and pharmacists is Drug Utilization Review (DUR). AMR created a quick reference guide to DUR so you […]

The Evolution of Health Plans

The health plan you purchase today may not resemble the plan of your parents or grandparents at all. For decades, Americans received healthcare under the traditional fee-for-service system. Insurance companies reimbursed patients or payers based on every service provided to patients. This seemed logical on the surface, yet problems became clear as the industry realized […]

Peer Review: Benefiting Patients and Physicians

Many physicians are experts in their areas of practice, but the medical field is vast, and there’s no way for one doctor to be an expert in everything. It is impossible to keep up with each advancement for every condition or treatment option. That is why physicians and health care facilities use the peer review […]

The Latest on Obesity, Diet & Exercise

The United States has long heard it has an obesity epidemic. According to the U.S. Centers for Disease Control and Prevention, 36.5 percent of U.S. adults are obese, which leads to health problems like heart disease, type 2 diabetes, certain cancers and premature death. But being overweight is not just a problem for people in […]

Workers’ Compensation: Keeping Workers Safe by Prioritizing Prevention

Adults spend a significant amount of their lives at work. Some individuals have 9-to-5 desk jobs while others hold more physically demanding positions in agriculture, manufacturing and construction. Whatever the work environment, employees expect to be safe from unreasonable dangers and to be able to get up and go to work again the next day. […]

Days of Change – Workers’ Compensation In 2017 [Infographic]

From the election to recent statewide regulations, Workers’ Compensation is bracing for big changes in 2017. Find out more in our infographic!

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