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And what has it achieved? The meaning and achievements of managed care change with the times, the context, the goals — and in the eyes of the beholders.
Administration comprises 25% of all healthcare costs, making it a key target for automation. Organizations are using AI to support documentation, coding, scheduling and more.
With current waiver deadline approaching, the AMA details the case for letting patients access this vital care modality.
The Case Manager I heard a story on NPR over the weekend about kindness. The reporter shared an experience that changed his life. One day, he was in the men's room at an airport, and a fellow traveler was washing his hands. When the traveler left, he said to the attendant standing in the corner, “Thanks for keeping it | WorkersCompensation.com
AbstractWe build and deploy machine learning models that accurately predict short- and medium-term inpatient outcomes for Hartford HealthCare, including 24–48 hour discharge, ICU transfer
Ethical standards are critical.
Becker’s asked five health system strategic leaders about the role value-based care plays in their system's strategic planning and how they're managing…
Behavioral health management doesn’t have to strain resources. Learn how the collaborative care model can reduce costs, scale resources, and transform patient care — without major investments.
Implementing a new VBC program in healthcare requires cross-functional support and overcoming numerous challenges
Burn injuries are severe traumas causing serious complications and high mortality. Managing burns is especially challenging in resource-limited settings. This study explores burn care challenges from the perspectives of both patients and healthcare providers. This qualitative descriptive study was conducted in Iran (2024–2025) with 41 hospitalized burn patients and healthcare providers, including physicians, nurses, psychologists, physiotherapists, and nutritionists. Participants were purposively sampled, and data were collected through semi-structured interviews until saturation. Data were analyzed concurrently using Graneheim and Lundman’s content analysis method with MAXQDA 2020 for data management. An inductive data analysis process revealed two main categories and nine subcategories. The categories identified were: “Structural and Professional Barriers in Burn Management” and “Challenges Related to Burn Patients and their Families”. Key structural barriers include inadequate interprofessional collaboration, limited resources and specialized expertise in non-specialized centers, insufficient burn care education in health profession curricula, and a lack of attention to burn injuries in health policy. Patient- and family-related challenges include cultural and economic factors, insufficient post-discharge follow-up, and low public awareness about burn injuries. This study highlights the multifaceted challenges in burn management from both healthcare providers’ and patients’ perspectives. Addressing these interconnected challenges requires comprehensive strategies encompassing healthcare system reforms, enhanced education and training, culturally sensitive care approaches, and supportive policies. Such efforts are essential to improve patient outcomes, reduce long-term complications, and alleviate the substantial burden of burn injuries on individuals and the healthcare system.
Explore why nurse career advancement matters, using insights from two recent reports, to show how growth and recognition drive satisfaction.
A practice-ready nurse is one who can make consistent, effective clinical judgements, and know when to ask for assistance, says this nursing leader.
Healthcare organizations face ongoing challenges like burnout and inefficiency, but a shift towards integrated technology and collaboration offers hope for improvement.
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Patient surveys rank Ochsner Health No. 3 nationally for care coordination as Medicare savings hit $44.8 million, showing value-based care can deliver on both.
The Case Manager I recently moderated a webinar for new nurses who wanted to pivot their careers into workers' compensation case management. We were discussing the competencies that nurse case managers need to bring to their jobs. One of the panelists said something that caught my attention. She said it is important that a nurse | WorkersCompensation.com
Improper payments, unnecessary utilization, and administrative inefficiencies represent persistent structural challenges within the United States healthcare system. This places significant pressure on healthcare spending. Value-based care (VBC), particularly through bundled episode payments and alternative payment models (APMs), has emerged not only as a potential cost containment strategy but also as a potential framework for strengthening payment integrity and promoting appropriate resource use.
This article examines how value-based care models, particularly bundled payments and APMs, strengthen payment integrity by addressing structural drivers of improper payments through improved transparency, accountability, and stewardship of healthcare resources across the care continuum. Bundled episode payments establish a single, prospectively defined payment for all services associated with a discrete episode of care, supporting greater predictability of spending and improved coordination across settings, while reducing fragmentation within the care continuum.
By shifting reimbursement away from volume-based incentives toward outcome-oriented accountability, VBC facilitates clearer evaluation of utilization patterns and enables earlier identification of unexplained variation through routine monitoring and analytics. These design features complement traditional oversight and utilization management efforts by addressing the underlying payment and delivery-system drivers of fee-for-service (FFS) reimbursement.
This technical report synthesizes existing evidence and policy analysis to examine how value-based care models address a critical policy gap by embedding payment integrity and utilization oversight within payment design, rather than relying solely on retrospective enforcement.
A recent report highlights the role of improved communi […]
Identifying predictors of patient engagement in a care coordination program for individuals with work disabilities using a continuum-based engagement definition
As we wrap up another year and get ready for 2026 to begin, it is once again time for everyone's favorite annual tradition of Health IT Predictions! We reached out to our incredible Healthcare IT Today Community to get their insights on what will happen in the coming year, and boy, did they deliver. We,
Monster’s 2025 Healthcare Market Report shows skyrocketing demand for nurses including CNAs, LPNs, RNs, and NPs. Learn why hiring is rising, what is driving shortages, and how nurses can leverage today’s job market.
Rural Americans face significant challenges in accessing primary care, but there are opportunities for policymakers and healthcare leaders to address these issues, according to a new issue brief from The Commonwealth Fund.
The Case Manager The US has the best ‘sickcare’ system in the world. Today, doctors and other healthcare professionals have numerous tools to keep people alive and treat them for complex conditions. One example is cancer care. Years ago, cancer was viewed as a terminal disease. Today, due to advances, cancer is now considered a | WorkersCompensation.com
The Case Manager In this week’s post, I wanted to let readers know that Case Management Week will take place from October 12th to 18th this year. While the official celebration runs from Oct. 12 to Oct. 18, the Case Management Society of America is recognizing case managers all month long with free and educational | WorkersCompensation.com
It's a growth industry, with a market value expected to exceed $63 billion by 2034
Oncology Nursing News connects oncology nurses and APPs with updates on therapy advances, side effect management, and patient-centered cancer care.
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Why Nurse Career Advancement Matters
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