These interventions are collectively referred to here as the
utilization management toolbox.
Active
utilization management benefits patients by decreasing the total cost of testing, and ultimately increasing the value of the test.
Breaking new ground in the healthcare IT sector, Infina Connect provides cloud-based drug
utilization management and care
utilization management solutions that have a profound impact on cost and outcomes for large patient populations.
Lastly, the level-of-care assignment, amount of case management services, and other services provided would be subject to the
utilization management review process.
Even if drugs are included in formularies, many plans may institute
utilization management tools, such as prior authorization.
According to the company, XBOB is the latest innovation in panel
utilization management systems.
Medicare Part D drug plans often employ
utilization management techniques, such as prior authorization, for commonly prescribed antidepressants and antipsychotics, according to a report from the Medicare Rights Center.
The premise on which managed care--particularly health maintenance organizations--was built included closed networks, tight
utilization management and capitation.
Richard Celko, DMD, MBA, and Certified Dental Consultant (CDC) is the national dental director of
utilization management for Aetna and president-elect of the American Association of Dental Consultants (AADC), the professional organization for dental benefits consulting, dental claims management and plan administration.
Levin, M.D., the national medical director of HealthHelp, a radiology
utilization management company based in Houston, Tex.
At United Healthcare, the
utilization management function was replaced by a fairly intensive effort to identify patients with chronic conditions that can be more effectively managed, she said.
Managed care organizations generally use three of the tools to reduce expenditures: selecting low cost providers, bargaining for lower rates, and
utilization management. The economic differences between managed care plans lie in which of these three tools are applied and to what degree.
