The need for supportive clinical partnership and streamlined processes to get patients the right care quicker has never been more critical. That’s why there is continuous work being done to improve utilization management. 

There are over 100 different types of known cancers, and out of those, three types are the most common in men and women. We've compiled information on symptoms, helpful tips, and stats on clinical trials on the most common types of cancer.

Mary* is a 60-year-old patient who has been experiencing balance issues. She has fallen several times. Her doctor identifies an abnormal walking pattern. Learn more and click through Mary's journey. 

Utilization management (UM) works to ensure that the right health care service is being issued to the right patient at the right time, with the least possible burden for patients and providers. This is not without challenges on the providers' end. Challenges like outdated manual processes, paperwork, and confusion on benefit packages. With recent regulations and legislation, there have been many advancements in the UM space but our work isn't done. 

Today’s complex, fragmented health care system doesn’t always meet individual care needs. It can also be burdensome for providers and often costs more than it should.

There may not be a more misunderstood part of the health care system than utilization management (UM). UM helps ensure that members receive health care services that are appropriate, necessary, and cost-effective. 

Leveraging evidence and expertise to improve the safety and cost of PVD care. 

60-year-old Don*, who was in a motor vehicle accident a little over a year ago, is still suffering from persistent back pain. Learn how EviCore helped both Don and his provider leverage clinical expertise through EviCore's utilization management. 

Unnecessary, potentially dangerous peripheral vascular interventions highlight the need for evidence-based care.

Creating better outcomes and experiences with a personalized concierge approach. 

From savings to plan performance, uncover the power of Radiology Site of Care management.

The Centers for Medicare & Medicaid Services (CMS) recently released its Advancing Interoperability and Improving Prior Authorization Processes final rule. We sat down with Chief Medical Officer Eric Gratias, M.D., to talk about how well prepared EviCore by Evernorth® is for the rule and what it means for patients, providers and payers.

Did you know laboratory tests influence two-thirds of clinical decisions? While the right tests enable better diagnoses and treatment, the wrong ones can often do more harm than good.

Explore our interactive infographic to learn how this proven program is driving provider adoption of high-quality oncology treatment regimens to improve patient health outcomes and lower drug costs. 

The fact that 25%–40% of musculoskeletal (MSK) care spending is wasteful or ineffective is concerning enough. But coupled with the knowledge that more than 50% of U.S. adults over 18 live with an MSK condition, the potential impact of low-value MSK care is staggering. 

Our solution: An evidence-based care approach to diagnostic care. 

See how EviCore helped a 50-year-old patient diagnosed with Barrett’s, avoid an unnecessary surveillance upper GI endoscopy.

Hear from EviCore President David Smith and the medical leadership team about the patient-centric benefits of EviCore’s evidence-based approach.

Alice* is a 50-year-old woman experiencing leg pain from a pinched nerve in her back.

While there are situations when hospital care is necessary, alternative sites like ambulatory surgery centers, freestanding imaging centers, and clinics are often the smarter choice.

Meet Renee, a 47-year-old office manager and married mother of two, and an EviCore patient whose life has been impacted by many of EviCore's solutions

Meet Jacob*, a 61-year-old man who received a diagnosis of stage III non-small-cell lung cancer last year. EviCore approved an evidence-based treatment that included chemotherapy and radiation therapy at a community cancer center. Jacob experienced an excellent response to treatment

Hear from Dr. Sheldon Scheinert, EviCore’s Associate Chief Medical Officer of Diagnostic Solutions, about how our program urges patients to get the colorectal cancer screenings they need.

Three-quarters of health care spending in the United States is due to avoidable chronic disease. Preventive care is one of the best ways to address this challenge; however, millions of Americans avoid preventive care every year.

Q&A from EviCore’s Dr. Lon Castle on Evidence-Based Lab Testing’s Ability to Improve Patient Outcomes & Reduce Costs

EviCore’s Dr. Robert Westergan on Managing Site of Care and Implants for Musculoskeletal Conditions in EviCore's newest insight for our MSK solution.

EviCore sat down with Dr. Sharon Nichols, a board-certified cardiologist, to understand how her team helps patients get evidence-based cardiovascular care to meet their needs.

Medical knowledge is growing at an unprecedented rate, which is accelerating every year. This information explosion has created a challenging environment for providers.

EviCore is working hard to reduce the time commitment of prior authorization through Evicore intelliPath^®, our solution to help automate providers’ interactions with us. We sat down with EviCore’s Vice President of Strategic Development, Jim Knickle, to learn more.

We sat down with EviCore’s Associate CMO for Oncology Programs, to talk about his team’s efforts to make sure patients get cancer care that’s aligned with the latest medical science. 

Q&A: EviCore’s Chief of Musculoskeletal Programs on the Need for Evidence-Based Care for Muscles, Bones and Joints.

No matter your role in healthcare, you're likely aware of prior authorization (PA). While some providers and patients find PA time-consuming and frustrating, it remains the best way to help ensure patients receive safe, appropriate and effective care at the lowest overall cost to U.S. healthcare. Recent advances in technology are making PA smarter, more automated and faster than ever before.

We sat down with Dr. Sheldon L. Scheinert, MD, FACG, Associate Chief Medical Officer of Diagnostic Solutions for EviCore. Dr. Sheldon L. Scheinert's job is to make sure patients get imaging tests like MRIs and CTs that are aligned with the latest medical science.

The Journal of Clinical Pathways has published a peer-reviewed study written by our EviCore oncology subject matter experts: “Improving Biosimilar Adoption Rates and Affordability With Oncology Pathways.”

The Increased Adherence to Molecular Profiling Recommendations in Non-Small Cell Lung Cancer (NSCLC) Through Use of Prior Authorization and Peer Review

The cost of cardiovascular disease goes beyond mortality and human suffering. Heart disease costs the United States more than $363 billion annually. Not all of the cardiovascular healthcare spending, however, is effective. In a recently released scientific statement, the American Heart Association notes that low-value cardiovascular care accounts for as much as 30 percent of this healthcare cost, meaning that over $100 billion is spent annually on care that does not improve the patient’s cardiovascular health.

Due to the current shortage of CT contrast, EviCore medical reviewers are following guidance regarding the appropriate alternative imaging studies, according to our evidence-based clinical guidelines for individual case scenarios.

While some newer approaches in the complex field of radiation oncology are still lacking sufficient evidence around efficacy, there is a type of radiation therapy—hypofractionation—that has proven to be highly effective and valuable for two of the most common cancers among women and men: breast cancer and prostate cancer.

Recent advances in radiation oncology treatments offer promising alternatives for the nearly 2 million patients diagnosed with cancer in the U.S. each year. One of these treatments is stereotactic body radiation therapy (SBRT). Also known as stereotactic ablative body radiation (SABR), this type of radiation was first used in the early 1990s.

One in seven women diagnosed with breast cancer is “overdiagnosed,” according to a new study published in the Annals of Internal Medicine. That means they were diagnosed with tumors that would’ve caused less harm if they’d remained hidden.

Learn more about the field of radiation oncology and how evidence-based guidelines enhance patient-centered care from Dr. Nimi Tuamokumo, EviCore Senior Medical Director and Radiation Oncologist.

Watch our February 15th webinar with Margaret Rausa, EviCore’s Vice President, Oncology Strategy and Growth, and Dr. Rajanish Singla, EviCore’s Chief of Radiation Oncology, who will provide an overview of Radiation Oncology for health plan representatives.

U.S. families are drowning in healthcare costs. The median U.S. household spends approximately 20% of disposable income on healthcare, with a projection of $6,832 in yearly premiums and $3,306 on out-of-pocket costs such as deductibles, copays, and coinsurance in 2022. Hospital costs alone have risen 600% since 1990.

Welcome to the final 2021 edition of our Ask EviCore feature! In this month’s edition, we’re sharing a list of resources to help you navigate the prior authorization process so you can provide the best, medically appropriate care to your patients.

Learn more about the work EviCore's Advanced Analytics R&D team does to support the business with a spotlight on an analysis on conservative therapy for low back pain. 

Here are a few ways you can prepare for the holiday, including four exercises for low back pain you can try at home.

Listen on-demand for the insights of Miriam Sznycer-Taub, Director with Advisory Board’s Ecosystem Research team. She will discuss the rising popularity of home-based care and what that likely portends for the future of our healthcare system.

Choosing a home care provider is one of the hardest decisions family caregivers make. Preparing your populations with quality vetting questions can help them feel more empowered about making the best choices for their family.

By providing care in a setting that is comfortable for patients, helpful for providers, and affordable for payers, home health services help improve outcomes and reduce costs. Learn more about the benefits of quality in-home healthcare.

In-home healthcare is a way of extending provider support to the place where patients spend the bulk of their time. Here are four ways to engage home health services for better outcomes and more informed care during in-person visits.

Bonus! Tune into our latest Auth the Cuff podcast episode featuring pediatric oncologists Dr. Michelle Neier and Dr. Jessica Roberson, along with pediatric radiologist Dr. Keith Kronemer, who speak with Dr. Emily Coe on the impact COVID-19 has had, and may continue to have, on pediatric care

This month, we’re sharing updates about a new enhancement to our web portal. Our team is proud to announce that the e-notification feature now allows a portal user to opt-in to receive e-notification—real-time updates—about the status of their prior authorization case.

Listen to American Physical Therapy Association (APTA) leaders Elise Latawiec and Kelly Sanders, and EviCore healthcare musculoskeletal leaders Dr. Robert Westergan and Victoria Rupakus, in a discussion moderated by medical benefits management veteran, David Baird. Learn more about (1) the value of musculoskeletal conservative care, (2) virtual care and its effect on physical therapy, and (3) the future of conservative care.

People affected with musculoskeletal conditions may be able to take advantage of virtual care treatment options. Learn how virtual care uses platforms to connect a patient directly to their physician, their physical therapist, or their chiropractor, as well as apps, software, and wearable devices.

Here are some of the trends in fertility we are seeing—and what they portend for the future of the fertility market and individuals ready to embark on a fertility journey.

As there is a wide variety of things that can go wrong with the body's muscles, cartilage, tendons, joints, and spinal discs, there is also a wide variety in how health insurance plans pay for treating musculoskeletal conditions. Variations in benefit structure can have a demonstrable impact on access to appropriate care.

Specialized therapies such as chiropractic, acupuncture, and physical therapy are cost-effective and can provide improved outcomes for chronic pain patients. Tune into our recent podcast episode with EviCore's post-CAM program specialists Dr. Chanta Van Laanen, Dr. Laura Beitz-Walters, and Dr. Mark Leichter to learn more.

Musculoskeletal pain is now recognized as a national public health problem. Effective pain management improves a patient's quality of life, reduces costs for all involved, and disrupts the vicious cycle of opioid dependency. Learn how coordination of care for musculoskeletal conditions makes a difference.

Well before the pandemic, consumers were leaning towards home healthcare versus facility-based care when appropriate for a number of reasons. Learn about the growing field, along with EviCore and Alegis Care's home solutions on our new Auth the Cuff podcast episode with Dr. Yvette LeFebvre, Chief of PAC/DME/Sleep Services

Join nationally known Medicaid Managed Care consultant and expert Billy Millwee, President and CEO of Millwee Associates, and Yvette LeFebvre, DO, Clinical Chief of Post-Acute Care, DME, and Sleep Services for Evernorth Home Solutions. They discuss the rapidly changing Medicaid Managed Care environment, and steps that Managed Medicaid health plans can consider to ensure continued success.