Utilization management

Avalon Saves Clients Millions, Sees Record Growth in 2023

Retrieved on: 
Tuesday, February 27, 2024
Chronic kidney disease, Insight, CKD, Organization, Patient, Policy, Genetic testing, Utilization management, Disease, Diagnosis, NCQA, Science, National Committee, HITRUST, Quality assurance, Medical device

TAMPA, Fla., Feb. 27, 2024 /PRNewswire/ -- Avalon Healthcare Solutions, the world's first Lab Insights company, enjoyed record-setting growth in 2023 while helping its health insurer clients save money, improve operations, and ensure the highest quality care for their members. That year, Avalon clients realized approximately 10% to 20% savings on their outpatient lab spending across lines of business. Approximately 25% of those savings benefit member spending and member out-of-pocket costs.

Key Points: 
  • TAMPA, Fla., Feb. 27, 2024 /PRNewswire/ -- Avalon Healthcare Solutions , the world's first Lab Insights company, enjoyed record-setting growth in 2023 while helping its health insurer clients save money, improve operations, and ensure the highest quality care for their members.
  • That year, Avalon clients realized approximately 10% to 20% savings on their outpatient lab spending across lines of business.
  • Due to this emphasis, Avalon experienced record growth in 2023.
  • Also, in 2023, Avalon launched Precision Genetic Testing Management (PGTM), the next evolution of its genetic test management solution.

New Medecision Research Reveals Top Barriers Holding Health Plans Back from Reducing Costs, Improving Outcomes, Streamlining Efficiencies

Retrieved on: 
Wednesday, February 21, 2024
Population health, AI, System, Frustration, Automation, Utilization management, Machine learning, Research, Management

DALLAS and KING OF PRUSSIA, Pa., Feb. 21, 2024 /PRNewswire/ -- Medecision, the leading clinical data and analytics platform company, has announced the release of its comprehensive research report, "The State of Utilization Management, Care Management, and Population Health in 2024." This in-depth study provides critical insights into the current landscape and future trends in health plan strategies and technologies.

Key Points: 
  • This in-depth study provides critical insights into the current landscape and future trends in health plan strategies and technologies.
  • The research highlights the challenges health plan leaders face and unveils surprising findings, notably the gap between executives' recognizing the importance of personalization and the current state of implementation.
  • "The insights from our research reveal that health plan leaders are at a turning point, grappling with outdated tech and fragmented data.
  • " The State of Utilization Management, Care Management and Population Health in 2024 " is based on independent research conducted by healthcare consultancy Sage Growth Partners.

ZeOmega Partners With Datycs to Digitize Faxed Documents and Automate Healthcare Data Workflows

Retrieved on: 
Tuesday, January 30, 2024
Eye, FHIR, NLP, Partnership, Fax, CMS, Utilization management, Organization, Automation, Medical device

PLANO, Texas, Jan. 30, 2024 /PRNewswire/ -- ZeOmega®, the leading population health management organization, today announced its partnership with Datycs, a leading provider of clinical AI/Natural Language Processing (NLP) solutions, to automate converting unstructured data from faxed documents into standardized, interoperable, and actionable information. The collaboration will help health plans garner insights that will drive improvements in member care, provider and payer workflows, and overall efficiency.

Key Points: 
  • The collaboration will help health plans garner insights that will drive improvements in member care, provider and payer workflows, and overall efficiency.
  • Digitizing faxed documents and applying these technologies to interpret content will help ZeOmega's clients operate more efficiently and achieve greater cost-savings, member satisfaction, utilization of resources, and effectiveness of services.
  • "We are very enthusiastic about our collaboration with Datycs and anticipate engaging in innovative teamwork," said Suhas Ramachandra, VP, Product, Strategy, and Innovations, ZeOmega.
  • "Such partnerships harmonize seamlessly with ZeOmega's partner ecosystem, enabling us to deliver top-tier solutions and further emphasize our dedication to excellence and value."

Stellar Health Appoints Rebecca Schwietz as New Chief Operating Officer

Retrieved on: 
Tuesday, January 23, 2024
Stellar, Entrepreneurship, Utilization management, Bright Health, Growth, Management

NEW YORK, Jan. 23, 2024 /PRNewswire/ -- Stellar Health, a healthcare technology company focused on revolutionizing value-based care, is pleased to announce the appointment of Rebecca Schwietz as its new Chief Operating Officer (COO).

Key Points: 
  • NEW YORK, Jan. 23, 2024 /PRNewswire/ -- Stellar Health, a healthcare technology company focused on revolutionizing value-based care, is pleased to announce the appointment of Rebecca Schwietz as its new Chief Operating Officer (COO).
  • Schwietz joins Stellar Health with an impressive background in healthcare operations and strategy.
  • "As Stellar Health continues to expand and scale its business, it is crucial to bring aboard the right leadership," said Michael Meng CEO and Co-Founder of Stellar Health.
  • "It is an honor to join the Stellar Health team during this exciting phase of growth and innovation," said Schwietz.

Sagility Introduces Utilization Management as a Service to Improve Prior Authorization, Mitigate Costs

Retrieved on: 
Thursday, December 14, 2023
General Health, Other Health, Health, Practice Management, Health Insurance, Medicare Advantage, Pressure, UM, Senior, Commercial, Utilization management, URAC, BPM, UMAA, Ratio, CMS, Pain, Medicare, NPS, Endoscopy, MLR, Overalls, Health insurance, Medical device, Nursing, Medicaid, Sagil

Utilization management (UM) and prior authorization, which is the most commonly practiced form of utilization management, are both highly regulated, and health plans can face high penalties and fines when they are out of compliance.

Key Points: 
  • Utilization management (UM) and prior authorization, which is the most commonly practiced form of utilization management, are both highly regulated, and health plans can face high penalties and fines when they are out of compliance.
  • The existing U.S. nursing shortage is one factor exacerbating the pain for payers who struggle to render decisions in a timely manner.
  • In late 2022, CMS proposed a mandate that requires payers to turn around cases faster, as well as provide real-time decisions.
  • Sagility serves Commercial, Medicare Advantage, Medicaid, children’s health plans, and qualified health plans in all 50 states.

Stoneweg US' Thomas Stanchak Named 2023 GlobeSt Multifamily Real Estate Influencer

Retrieved on: 
Monday, October 16, 2023
Arrell Global Food Innovation Award, ESG, Utilization management, Internet celebrity, Education, Biophysical environment, Water, Commercial property, Cryptocurrency, Management, Sustainability, Social

ST. PETERSBURG, Fla., Oct. 16, 2023 /PRNewswire/ -- Stoneweg U.S., LLC ("Stoneweg US") proudly announces Thomas Stanchak, Director of Sustainability, as a 2023 GlobeSt.

Key Points: 
  • ST. PETERSBURG, Fla., Oct. 16, 2023 /PRNewswire/ -- Stoneweg U.S., LLC ("Stoneweg US") proudly announces Thomas Stanchak, Director of Sustainability, as a 2023 GlobeSt.
  • Influencer in Multifamily Real Estate.
  • This prestigious recognition acknowledges his outstanding contributions, remarkable achievements, and vision for the multifamily real estate investment sector.
  • Receiving the 2023 Influencers in Multifamily Real Estate award is a testament to Stanchak's pioneering spirit and unwavering commitment to sustainability.

Acentra Health Awarded Contract Extension Overseeing Utilization Management Services for Florida Medicaid

Retrieved on: 
Thursday, September 7, 2023
Florida Medicaid waiver, Utilization management, Medicaid, AHCA, URAC, Health, Partnership, Manager, Medicaid managed care, Health insurance, Nursing

MCLEAN, Va., Sept. 07, 2023 (GLOBE NEWSWIRE) -- Florida’s Agency for Health Care Administration (AHCA) awarded Acentra Health (formerly Kepro) a new five-year contract extending the company’s 12 years of work overseeing utilization management services for beneficiaries enrolled in the state’s fee-for-service Medicaid program and those receiving select Medicaid Managed Care carve-out services.

Key Points: 
  • MCLEAN, Va., Sept. 07, 2023 (GLOBE NEWSWIRE) -- Florida’s Agency for Health Care Administration (AHCA) awarded Acentra Health (formerly Kepro) a new five-year contract extending the company’s 12 years of work overseeing utilization management services for beneficiaries enrolled in the state’s fee-for-service Medicaid program and those receiving select Medicaid Managed Care carve-out services.
  • “We are grateful to be recognized for the success of our strong partnership with Florida’s Agency for Health Care Administration and this opportunity to continue serving individuals and families who rely on the state’s Medicaid program,” said Acentra Health CEO Todd Stottlemyer.
  • Services provided span 18 areas of utilization review in fee-for-service Medicaid covering one million Florida beneficiaries, including inpatient acute medical surgical and psychiatric services, and enhanced care coordination for beneficiaries receiving select services.
  • Other services include provider and beneficiary outreach and a call center.”
    As a URAC-accredited organization for Health Utilization Management, Acentra Health adheres to the highest standards and best practices in case review backed by experienced, credentialed clinicians and national expert resources.

Blue Cross Blue Shield of Michigan takes more steps to improve prior authorization process; getting members faster access to care

Retrieved on: 
Thursday, September 7, 2023
Blue Cross Blue Shield Association, Blue Cross, Prescription, Blue, Gold, Automation, Physician, Nursing, Health, Utilization management, Safety, Health insurance, Pharmaceutical industry

DETROIT, Sept. 7, 2023 /PRNewswire/ -- Blue Cross Blue Shield of Michigan, a national leader in streamlined prior authorization programs, is further reforming its process to relax approximately 20% of prior authorization requirements. This is part of Blue Cross' ongoing effort to improve health care quality, experience, access and affordability for members, while also reducing administrative tasks for clinicians.

Key Points: 
  • This is part of Blue Cross' ongoing effort to improve health care quality, experience, access and affordability for members, while also reducing administrative tasks for clinicians.
  • Blue Cross' prior authorization program promotes quality and patient safety for members and provides assurance that the member gets effective care at the appropriate time.
  • Blue Cross Blue Shield of Michigan is known in the Michigan's clinical community for streamlining our prior authorization process through technology and an extensive gold-carding program.
  • Blue Cross Blue Shield of Michigan, a nonprofit mutual insurance company, is an independent licensee of the Blue Cross and Blue Shield Association.

In June 2023, the Percentage of Asynchronous Telehealth Claim Lines for Mental Health Conditions More than Doubled in the Midwest

Retrieved on: 
Wednesday, September 6, 2023
Infection, DSM-IV codes, Hypertension, Medicare, Diagnosis, Medicare Advantage, Medicaid, Psychotherapy, Utilization management, Mental, Rare-earth element

NEW YORK, Sept. 6, 2023 /PRNewswire/ -- In June 2023, the percentage of asynchronous telehealth claim lines for mental health conditions more than doubled in the Midwest, according to FAIR Health's Monthly Telehealth Regional Tracker.1,2 In that region, mental health conditions rose from 15.9 percent of asynchronous telehealth claim lines in May to 36.0 percent in June and replaced hypertension as the number one diagnosis. Nationally, mental health conditions also rose, moving from number five to number four among the top five diagnoses via asynchronous telehealth. The data represent the privately insured population, including Medicare Advantage and excluding Medicare Fee-for-Service and Medicaid.

Key Points: 
  • Nationally, mental health conditions also rose, moving from number five to number four among the top five diagnoses via asynchronous telehealth.
  • National telehealth utilization remained stable at 5.4 percent of claim lines in both May and June 2023.
  • In the Midwest, however, telehealth utilization decreased by 2.4 percent, while in the three other census regions it remained unchanged (0.0 percent).
  • In June, the percentage of telehealth claim lines for acute respiratory diseases and infections continued to decrease nationally and in all regions.

Nebraska Methodist Health System Partners with Avant-garde Health to Enhance Surgical Coding and Billing Accuracy

Retrieved on: 
Tuesday, July 18, 2023
Professional Services, Health, Surgery, Practice Management, Finance, General Health, Fintech, Customer success, CDI, EMR, Nebraska Methodist Health System, Utilization management, Clinical coder, Medical device, Audit

Avant-garde Health , the leading provider of solutions for improving perioperative quality and profitability, is helping Nebraska Methodist Health System enhance the accuracy of coding and billing for surgical procedures.

Key Points: 
  • Avant-garde Health , the leading provider of solutions for improving perioperative quality and profitability, is helping Nebraska Methodist Health System enhance the accuracy of coding and billing for surgical procedures.
  • “We are very happy with the gains we’ve achieved with the Avant-garde CareMeasurement Coding software and assistance from their Customer Success team,” said Marilyn Voss, Director of Clinical Coding, CDI and Utilization Management for Methodist Health System.
  • Avant-garde supplements coding reviews with a unique approach that pinpoints errors missed by traditional tools, practices, and services.
  • “The Nebraska Methodist team is highly skilled and the results they’ve achieved with our unique CareMeasurement Coding solution are impressive.