While utilization management viamanaged vision care is great on paper, the proof really comes inthe care and costs to members in a U.S. health care environmentfocused on integration and cost containment. (Photo:Shutterstock)
In managed care and benefits, medical management hastraditionally referred to care insurance providers and medicalprofessionals working together to determine best practices andservices to improve both quality and outcomes for plan members. However,over the last decade, medical management has been adapted to meetpayers and medical professionals on their own terms in the evolvingU.S. health system—and has come to mean anything from trueutilization management (the purest definition), to pre- andpost-claim submission, steerage or even the “gatekeeper” model.
The result is a very common term that no longer lives up to itsoriginal definition.
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