by Jack Hurley
Medical Cost Management Corp.

Before trying to answer that question, let’s take a look at a little background. Utilization management organizations have been controlling costs for close to a quarter of a century. What was once a radical idea is now accepted as a necessary component to any health plan? Medical necessity is confirmed and unnecessary hospitalizations, bed days and surgeries are avoided.

by Scott MacStravic, Ph.D.
Principal, Durable Value Marketing

There was a time when “medical management” meant the management of diagnosis and treatment services dealing with acute diseases and injuries. Both “case” and “care” management have been common for years, as payors have used these forms of medical management to promote quality and reduce costs of treating individual patients. But now, medical management increasingly includes the proactive management, by medical means, of health, not merely the reactive management of disease and injury.

by J. William Comer, MD

Medical Director, KePRO

As the cost of medical care continues to escalate, the search widens for effective and comprehensive initiatives to control and balance both overall costs and the expenses of individual beneficiaries, while still ensuring that we achieve positive outcomes for our members/patients/employees.