April 20, 2016

Since the advent and expansion of utilization management (UM) systems in the 1980’s, many changes and enhancements have been implemented.  Among other changes, many UM programs are now embedded in integrated medical management delivery models that often appear seamless to the patient or ordering provider.  Of course, many of the fundamental tools used in UM […]

April 11, 2016

The evolution of utilization management (UM) interventions continue to open up new ways to promote best practices.  To that end, many health plans, care management organizations and other sponsors of UM programs have begun to focus on promoting emerging “patient safety” protocols even if these add to the over-all costs of paying for insurance. A […]

April 1, 2016

Workers’ compensation programs, as we know them today, have evolved over a 30-year period.  Over time, benefits were standardized, cost-containment and equity with state regulations was addressed, and return to work programs that benefit workers were introduced. As this evolution continues, the need to contain costs continues to be critically important. In 2011, state and […]

March 16, 2016

Over the last 30 years, accreditation organizations have assumed an increasingly important role in filling regulatory gaps by establishing quality standards before similar provisions are adopted by states and federal governments. Supporters of private sector accreditation programs note that these nonprofits can work more efficiently create quality standards that fill important gaps in the health […]