Leveraging Utilization Management to Reduce Medical Loss Ratio Rebates
Medical loss ratio (MLR) rebates hit a record $1.3 billion in 2019 because health plans spent too little on medical claims and too much on administrative costs. How can health…
Debbie Hill, MSN, RN, is a master’s prepared registered nurse with over 30 years’ experience in healthcare. She is the Senior Director for Utilization Management and Appeals & Grievances Product Applications at Medecision. Her role as a clinical consultant to the platform engineering team includes research, product development, and application deployment for healthcare payers serving Medicare, Medicaid, and commercial lines of business.
Risk Sharing Requires Health Plans to Hone Utilization Management Process
Healthcare organizations’ success under risk sharing and value-based care relies on a well-oiled UM program.
“Utilization Management” is all about saving health plans money. Or is it?
Until recently, Utilization Management was all about how health plans determine preauthorization. But that definition is fast becoming outdated.
Utilization management: What’s it got to do with population health?
What does Utilization Management have to do with Population Health? The answer: everything.