Straight talk--new approaches in healthcare. Want better relationships with payors? Focus on medical management.
When it comes to managing medical care for their enrollees, payors are moving towards a broader focus for medical management that includes both costs and quality. In the twelfth installment of Straight Talk, we look at how health plans, such as CIGNA, are developing incentives to reward high-quality, low-cost providers of medical care and transitioning their utilization management operations to a new model. To ensure quality, they are beginning to compare providers' performance to national standards for medical outcomes. Through these initiatives, known as "medical management," payors hope to improve not only medical care but also their relationships with providers.
Shea
Mary Ann
MA
Kang
Jeffery
J
Battaglia
Richard G
RG
D019090:Case Management; D003299:Cooperative Behavior; D019468:Disease Management; D006761:Hospitals; D006801:Humans; D007348:Insurance, Health / Q000639:trends*; D017063:Outcome Assessment, Health Care; D010346:Patient Care Management / Q000191:economics* / Q000592:standards; D010820:Physicians; D011785:Quality Assurance, Health Care; D012052:Reimbursement, Incentive / Q000639:trends*; D014481:United States; D014600:Utilization Review / Q000639:trends*