Analytical and Data-Based Decision Making in Case Management Course Logo

Analytical and Data-Based Decision Making in Case Management

Green Clock Hours: 1.75

Millions of people use health insurance in the U.S. The data that healthcare providers (HCPs) provide to insurance companies, or payers, is used to help make decisions based on the medical necessity of the treatment and cost. Data is being applied in ways never before seen by payers and providers to drive healthcare improvement through an analytic approach. Data can be applied to improve healthcare costs, quality, and outcomes. To understand how data is being utilized, you must first understand the broad perspective of what experts are calling the “data revolution” in healthcare, or the “age of big data.” It is also important to know what this means from a technology perspective.

There is also a micro-level of healthcare data application within the payer setting that has different ways in which data is helping payers to improve overall population health, manage healthcare costs, and inform the creation of innovative pilot programs. For those working in a healthcare setting, it is important to know how healthcare data is applied from a payer’s perspective. This includes member case management selection, the intersection of healthcare data and member preference, and how data is being used to inform best practices through medical necessity criteria (MNC) and clinical guidelines.



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$19.95

Course Description

Millions of people use health insurance in the U.S. The data that healthcare providers (HCPs) provide to insurance companies, or payers, is used to help make decisions based on the medical necessity of the treatment and cost. Data is being applied in ways never before seen by payers and providers to drive healthcare improvement through an analytic approach. Data can be applied to improve healthcare costs, quality, and outcomes. To understand how data is being utilized, you must first understand the broad perspective of what experts are calling the “data revolution” in healthcare, or the “age of big data.” It is also important to know what this means from a technology perspective.

There is also a micro-level of healthcare data application within the payer setting that has different ways in which data is helping payers to improve overall population health, manage healthcare costs, and inform the creation of innovative pilot programs. For those working in a healthcare setting, it is important to know how healthcare data is applied from a payer’s perspective. This includes member case management selection, the intersection of healthcare data and member preference, and how data is being used to inform best practices through medical necessity criteria (MNC) and clinical guidelines.



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