Utilization management builds on the gradual accumulation of experience and data that suggest that externally applied assessments of the appropriateness of proposed medical services can constructively influence how care is provided and, as one consequence, help constrain healthcare costs.
If executed well, utilization management can play a critical role in improving the overall experience for everyone involved and enhance patient outcomes.
In the post-depression era, private insurance grew popular for financing healthcare amidst steeply increasing costs, prompting the federal government to control expenses.
Various large organizations implemented their own utilization management programs for employee benefits, reacting to concerns of unnecessary medical procedures being recommended.
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