Understanding Utilization Management Policy: How to Manage This Increasingly Complex Environment in Collaboration and With Better Data

Am Soc Clin Oncol Educ Book. 2018 May 23:38:135-138. doi: 10.1200/EDBK_200891.

Abstract

As innovation in cancer care continues and newer costly therapies receive approval, utilization management will continue to grow as an important way that payers can attempt to control costs and value while providing service to their patients. Although utilization management may be necessary, it takes many forms and is optimized when it ensures appropriate patient access to services and minimizes administrative burdens of physicians and staff. These opportunities are best explored in collaboration with payers. Information systems today provide an excellent platform for data sharing to facilitate collaborative efforts between care delivery organizations and payers to optimize these efforts. As state and national policies differ regarding utilization management, it is important for clinicians to be both aware and involved.

Publication types

  • Review

MeSH terms

  • Health Care Costs
  • Health Policy*
  • Humans
  • Patient Acceptance of Health Care*
  • Patient Care Management*
  • Quality of Health Care