Category: Utilization Management

Optimize Your MLTSS Program to Effectively Manage Your Complex Populations

Optimize Your MLTSS Program to Better Manage Complex Populations For states and health plans operating managed long-term services and supports (MLTSS) programs, effectively managing individuals with complex, long-term care needs requires more than coordinating services. It demands an integrated, person-centered approach that connects medical, behavioral, and social care, supports member independence, and ensures access to… Continue reading Optimize Your MLTSS Program to Effectively Manage Your Complex Populations

From Frustration to Satisfaction: How to Transform the Prior Authorization Experience

In the last decade, the healthcare industry has seen more traction in the idea of addressing behavioral health treatment as part of whole-person care, also known as person-centered care. The pandemic has brought mental health to the forefront in a way it has never been before, expanding integrated behavioral health to a genre of conditions that… Continue reading From Frustration to Satisfaction: How to Transform the Prior Authorization Experience

Effective Care Coordination Addresses All Determinants of Health to Improve Health Equity

Although health outcomes are influenced not only by medical conditions, but the behavioral and social factors that impact a patient’s well-being, healthcare systems have traditionally focused their efforts primarily on physical and behavioral health. Social determinants of health (SDOH), however, can impact as much as 80 percent of health outcomes and can be a significant cost driver.… Continue reading Effective Care Coordination Addresses All Determinants of Health to Improve Health Equity