In February 2019, the Centers for Medicare and Medicaid Services (CMS) issued new requirements for Medicaid, the Children’s Health Insurance Program, Medicare Advantage plans and Qualified Health Plans, mandating they provide enrollees with immediate electronic access to health data by 2020. So what do these new requirements mean for those payers?
Healthcare organizations’ success under risk sharing and value-based care relies on a well-oiled UM program.
Research shows that social determinants of health (SDoH)—such as housing, transportation, access to healthy food and more—are linked to patient outcomes. Managed care organizations are partnering with community and social support providers to address SDoH to deliver better health outcomes.
Until recently, Utilization Management was all about how health plans determine preauthorization. But that definition is fast becoming outdated.
What does Utilization Management have to do with Population Health? The answer: everything.