Archive | Utilization Management

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!

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 […]

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