What does Utilization Management have to do with Population Health? The answer: everything.
Authored by Debbie Hill, MSN, RN
Utilization management isn’t just an insurance concept anymore. Because no hospital or health system has unlimited care resources, all have to develop “utilization management” skills. It’s a matter of deploying finite resources where they’ll have the greatest impact, within budget realities and new demands on care resources. It’s not just an essential part of payer or hospital operations; it’s an essential element of any successful population health initiative.
That’s because population health management is really a call for a higher, more strategic degree of utilization. It’s all about the best use of resources to treat groups of patients whose shared conditions consume the highest levels of care. With cost containment half of the equation, the solution can’t be to pile on more resources. But it obviously can’t mean withholding needed care for some patients to divert resources to others, either.
Instead, the idea is to deliver proactive, preventive care to patients rather than high-cost measures such as repeat hospital visits once a patient’s condition has deteriorated. Zeroing in on where to devote cost-effective resources on the front end to reduce the need for more costly resources later creates a win-win scenario, but it does require new resources and technologies.
That’s the new part of population health for hospitals and health systems. The key is finding technologies that provide a return on investment for population health programs. Fortunately, from technology partners to health plans, resources are at work today helping forward-looking hospitals and health systems improve utilization management to achieve better health for patients, and a more sound overall cost structure.
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Deliver Game Changing Care Management Through Efficient Utilization Management
About The Author: Debbie Hill, MSN, RN
Debbie Hill, MSN, RN, is a master’s prepared registered nurse with over 30 years’ experience in healthcare. She is the Senior Director for Utilization Management and Appeals & Grievances Product Applications at Medecision. Her role as a clinical consultant to the platform engineering team includes research, product development, and application deployment for healthcare payers serving Medicare, Medicaid, and commercial lines of business.
More posts by Debbie Hill, MSN, RN