6 December 2022Alex D'souzaManaging Editoreditor@healthcarebusinessreview.comHealthcare utilization management is constantly evolving due to advancing technology and the intent to improve patient care and adherence to medications while reducing costs for all stakeholders. With an industry full of opportunities and challenges, knowing how and when to identify and act on them is crucial to optimizing outcomes.Arguably, one of the most significant advancements in utilization management is the ability to use real-time healthcare data analytics that provide a daily update of changes in the market. Benefits managers can construct and review reports that allow them to identify opportunities immediately and take action quickly.The addition of physician advisors and clinical documentation improvement (CDI) specialists to the healthcare utilization review process has also resulted in significant performance gains. The inclusion of doctors in case management teams helps to accurately assess medical necessity because they offer insightful clinical judgment. To put the spotlight on such key developments in the industry, Healthcare Business Review illustrates how the healthcare utilization management space is leveraging new trends like predictive analytics and CDI specialists. This edition also features thought leadership articles from subject matter experts. Some of the exclusive insights are authored by Jennifer Mulligan, LCSW, Director of Behavioral Health Utilization Management, MetroPlusHealth; and Maryanne Bourque, Director, Utilization Management, Nurse Case Management, and Complex Scheduling, at Nemours. They shed light on managed care organizations (MCOs) that are contracted to provide administrative support as well as assist healthcare officials in meeting necessary health maintenance standards, disease management, and overall coordination of care. In this edition of Healthcare Business Review, we also bring to you the story of the top healthcare analytics solution providers. In the list, Health Network One stands out for offering its expertise in Physical, occupational, and speech therapy; dermatology; vision and ophthalmology; podiatry; and gastroenterology and urology. Equally commendable is the story of Monroe Plan for Medical Care, which offers medical and behavioral health and reviews pre-service, concurrent, and post-services for all service categoriesThrough the following pages, we aim to shine a light on the innovative trends and latest developments in the healthcare utilization management industry. We would like to know your thoughts.Leading the Edge with Predictive Analytics and AIEditorialManaging EditorAlex D'souzaEditorial StaffAaron PaulJoe PhillipJames SmithMark RobertVisualizerCopyright © 2022 ValleyMedia, Inc. All rights reserved. Reproduction in whole or part of any text, photography or illustrations without written permission from the publisher is prohibited. The publisher assumes no responsibility for unsolicited manuscripts, photographs or illustrations. Views and opinions expressed in this publication are not necessarily those of the magazine and accordingly, no liability is assumed by the publisher thereof.DECEMBER - 15- 2022, volume 05 - Issue 25 Published by ValleyMedia, Inc. To subscribe to Healthcare Business ReviewVisit www.healthcarebusinessreview.com Email:sales@healthcarebusinessreview.comeditor@healthcarebusinessreview.commarketing@healthcarebusinessreview.comImmanuelRonald DonovanDisclaimer: *Some of the Insights are based on our interviews with CIOs and CXOs
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