The latest approach of utilizing evidence-based medicine may be a key in further advancing healthcare reform
By Jay I. Pomerantz, MD – Executive Medical Director for Health Integrated

Utilization management, by definition[1], could be defined as, “The evaluation of the appropriateness, medical need and efficiency of healthcare services, procedures and facilities according to the established criteria or guidelines and in a cooperative effort with other parties, including members, groups, providers and payers to optimize the appropriate placement of patients to receive the appropriate services/supplies.” Quite a mouthful. This is but one definition, but it contains the key elements. Simply put, the goal of utilization management (UM) is to provide the most appropriate care based on case-by-case assessments. If accomplished, costs can be optimized as well. (more…)

PCMH is but one element of the changing landscape – we’re broadening the view to cover a broader range of key issues facing health care executives
By Jay I. Pomerantz, MD – Executive Medical Director for Health Integrated

We have had such a good response to the PCMH Community Blog since its inception last June. Thank you all for reading and sharing your thoughts. The comments and feedback we have received from you and others have been very positive.

Over the last year, we have facilitated the discussion around the PCMH and how this program could positively affect a health plan in today’s environment. There is no doubt that the potential impact of PCMH on health care remains strong. That said, you have asked that we address other key issues that you face on a daily basis in the constantly changing and dynamic healthcare environment we are all a part of today. We have heard your request.

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A broader perspective is needed in an evolving environment of limited resources and a growing patient population
By Jay I. Pomerantz, MD – Executive Medical Director for Health Integrated

Several weeks ago, we discussed the value of disease management (DM). We also took a poll and asked if the current DM programs were meeting your expectations. Although not scientific, 89% of you responded that they were not meeting your needs while 11% just didn’t know. DM programs are a part of most health plans, but like you, many do not feel they are meeting the needs of the patient, physician and health plan – the goal of which is to improve overall health while reducing cost. (more…)