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“Utilization Management” is all about saving health plans money. Or is it?

Debbie Hill Debbie Hill
Sr. Director, UM Product Applications

The term “Utilization Management” was first heard in healthcare roughly three decades ago. The Institute of Medicine came up with a formal definition in 1989 that discusses “…techniques used by or on behalf of purchasers of health care benefits to manage health care costs…”. In plain English: It’s how health plans determine preauthorization. Until very

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Utilization management: What’s it got to do with population health?

Debbie Hill Debbie Hill
Sr. Director, UM Product Applications

The answer: Everything. Utilization management isn’t just an insurance concept anymore. Because no hospital or health system has unlimited care resources, all have to develop “utilization management” skills. It’s a matter of deploying finite resources where they’ll have the greatest impact, within budget realities and new demands on care resources. It’s not just an essential

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Capitalize on chaos: How to zero in on opportunity with population health

Mary Kay Plona Mary Kay Plona

“In the midst of chaos, there is also opportunity.” –Sun-Tzu Healthcare is full of chaos today: regulatory reform, political uncertainty, rapid technological change, vast amounts of clinical and financial data, and the growth of alternative payment models. Yet the quote above is both powerful and true: chaos does breed opportunity. What healthcare organizations need to

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[WEBINAR] Population Health Issues and Opportunities: Spotlighting High Blood Pressure

Don Casey MD, MPH, MBA Don Casey MD, MPH, MBA
Chief of Clinical Affairs

Impacting nearly half of all adults in the U.S., more than 100 million Americans have high blood pressure, according to recent estimates from the American Heart Association. In addition to high costs of care, consequences of inadequate treatment include risk of cardiovascular disease, stroke, renal failure and early death. Health system teams committed to improving

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From program to business model: Using population health management to drive value-based care

Tamara Cull Tamara Cull
Senior Vice President, Aveus

What does “population health management” really mean? Many healthcare organizations think of population health management in terms of condition-specific programs designed to improve care and reduce costs for at-risk patients. Medicare’s bundled payment initiatives for joint replacements and cardiac care may come to mind, for instance. Very often organizations launch programs like these in response

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