While utilization management via managed vision care is great on paper, the proof really comes in the care and costs to members in a U.S. health care environment focused on integration and cost containment. (Photo: Shutterstock)

In managed care and benefits, medical management has traditionally referred to care insurance providers and medical professionals working together to determine best practices and services to improve both quality and outcomes for plan members. However, over the last decade, medical management has been adapted to meet payers and medical professionals on their own terms in the evolving U.S. health system—and has come to mean anything from true utilization management (the purest definition), to pre- and post-claim submission, steerage or even the “gatekeeper” model.

The result is a very common term that no longer lives up to its original definition.

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