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Navigating Medicare Advantage: Strategies for Hospitals to Tackle Growing Challenges

EvidenceCare

Written by Carol Howard, VP of Clinical Strategy As Medicare Advantage (MA) continues to grow, hospitals have faced growing challenges in navigating complex policies, payer friction, and financial pressures. These changes will impact how hospitals approach their contracts and denial strategies.

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Prior Authorization Is Changing

EvidenceCare

What Hospital UR & Revenue Cycle Teams Need to Know Written by Carol Howard, VP of Clinical Strategy A Brief History of Precertification Prior authorization (PA), originally known as precertification, began in the 1960s and expanded significantly during the rise of managed care in the 1990s. Kennedy, Jr.

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Engaging Physicians in Quality Improvement: Strategies for Driving Practice Change

EvidenceCare

When clinical teams embed learning into daily routines, reducing clinical variation becomes achievable and practice improvement in hospitals shifts from an initiative to a habit. Real-time dashboards can also flag length of stay variance, prompting collaboration to streamline processes and free up capacity for higher-acuity admissions.

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What Is Allied Health?

MedQuest College

Practical Nurses (LPNs) – Provide hands-on care to patients in hospitals, clinics, and long-term care facilities, including administering medications and monitoring health conditions under the supervision of registered nurses and physicians. Small Class Sizes: Personalized attention in a collaborative environment.

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Why Nursing Careers Are More Impactful Than Ever Before

We Care Online

They also influence hospital policies, improving patient care processes and outcomes through their leadership. They are collaborating with policymakers and nursing organizations to find solutions. However, the accelerated pace can be demanding, and the admissions process is competitive.

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How BPCI Enhances Patient Experience and Lowers Costs: A Comprehensive Guide

Guideway Care

Cost reduction strategies in BPCI focus on linking payment to performance, utilizing predictive analytics and interprofessional collaboration to lower expenses while maintaining high-quality care. At its heart, the BPCI program emphasizes strong collaboration between healthcare providers as essential for enhancing patient experiences.

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What do the Neighbourhood Health Guidelines mean for Practice Managers?

Practice Index

NHS England states that regional teams should be working with local government partners to set priorities for 2025/26, with an emphasis on improving timely access to general practice, urgent and emergency care, and reducing long and costly admissions to hospitals or care homes.