Sneak peek 👇

Risk scores are everywhere. Activation is not.

This is just a glimpse of our conversation with @PrealizeHealth on pressure testing your CM & UM platform.

Keep an eye our for the full webinar release on Monday!
#CareManagement #UtilizationManagement #ValueBasedCare #Elliginthealth

Committee hears mixed views on prior authorization changes, a $25,000 'high‑dollar' threshold and a 1332 reinsurance authorization Witnesses and regulators debated changes to utilization management — including a $25,000 numeric definition for 'high‑dollar' claims and narrowing of primary‑care prior‑authorization exemptions — and authorized agencies to apply for a Section 1332 reinsurance waiver to potentially lower premiums with federal pass‑through funding.

Vermont lawmakers are debating significant changes to healthcare management, including a new $25,000 threshold for 'high-dollar' claims and adjustments to prior authorization exemptions—what does this mean for patients and providers?

Click to read more!

#VT #UtilizationManagement

Prior Authorization, Quantity Limits, and Step Therapy for Antiemetics This cross-sectional study evaluates whether antiemetic drugs for patients with cancer who have Patient Protection and Affordable Care Act (ACA) Marketplace or Medicaid plans are subject to utilizatio...

#Priorauthorization #UtilizationManagement for costly 2nd-line 💊 is understandable but nearly one-half of plans have quantity limits for generic ondansetron, a cheap ($16 for 60 8mg tabs) & effective 1st-line drug

Make this make sense.
 
#fixPriorAuth
@michaelannica.bsky.social
@jamanetworkopen.com

1/ How closely do health plans’ drug #utilizationmanagement (UM) policies align with #clinicalguidelines? CEVR and NPC examined policies for 389 drug-indication pairs from 18 commercial insurers. Here’s a thread on what we found:

How Prior Authorization Impacts Care, Cost, and Clinical Workflows?

staffingly.com/how-prior-au...

#PriorAuthorization #HealthcareAdmin #UtilizationManagement #HealthTech #Staffingly

Utilization Management Risk Factors Unveiled | GameFi News Discover the hidden dangers of utilization management policies. New research reveals key risks & their impact on patient care.

LifeNextDaily News!
Worried about healthcare? New research quantifies the risks of utilization management policies & their impact on you! #UtilizationManagement #HealthcareRisk #PatientCare

Click here↓↓↓

California Assembly reviews AB 384 to eliminate prior authorizations for mental health emergencies Assemblymember Connolly presents AB 384 to reform mental health care access in emergencies.

California lawmakers are tackling the urgent issue of healthcare access with a groundbreaking bill that could eliminate prior authorization for mental health emergencies.

Learn more here

#CA #MentalHealthReform #UtilizationManagement #CitizenPortal

Eliminate the guessing game in step therapy - Capitol Weekly Utilized by both public and private insurers, step therap...

.@Capitol_Weekly features @ArthritisFdn & @CalRheum piece supporting #AB374 which would help ensure that treatments are based on the counsel of a doctor, not an insurance company. #steptherapy #utilizationmanagement https://bit.ly/38Qt5s0