Category: Utilization Management

Value-Based Care: Benefits and Challenges in the Current Healthcare System

The United States is a world leader in many categories. For instance, America spends more than any country on medical research and development and is at the forefront of developing automation and artificial intelligence technology. However, we also have the most expensive healthcare system in the world. Just last year, the U.S. spent $10,586 on […]

Healthcare Payers and Providers: Combining Resources with Technology Players to Control Costs

Physician selecting which tech tool to improve resource management and patient care.

The Affordable Care Act (ACA) has brought about a lot of changes in the healthcare industry in the United States. One such instance is the requirement of plans sold through the Health Insurance Marketplace to cover treatment for pre-existing medical conditions. Because of this, payers can’t deny coverage to high-risk patients or charge them exorbitant […]

Third-Party Reviewers: Offering Streamlined Solutions for Payment Integrity

Unfortunately, the healthcare industry faces challenges with financial waste. It has been estimated that the healthcare system in the United States wastes approximately $765 billion annually, about 25 percent of what is spent. Part of this number is due to payment integrity issues such as fraud, waste and abuse (FWA). If you’re not familiar with […]