In the past, preauthorization and other aspects of utilization management (UM) were effective in reducing inappropriate services and managing medical costs. However, traditional preauthorization lacks the speed, transparency and holistic approach necessary to maximize UM effectiveness. In this white paper, Matt Zubiller, vice president of Decision Management at McKesson Health Solutions, looks at the challenges health plans face with traditional authorization methods and describes both the components and the advantages of a prospective, exception-based approach.
Archive for November, 2011
In part two of his guest blog post for Healthcare Payer News, Emad Rizk, MD, president of McKesson Health Solutions, details the technology required to support the strategy for creating a health plan from scratch that he outlined in part 1. With these four key technology enablers, health plans will have the automation needed to excel in this new era of healthcare.
In a November article for Healthcare Payer News, Emad Rizk, MD, president at McKesson Health Solutions, asks readers to imagine if they could create a health plan from scratch. He then outlines the core competencies of the new health plan, including 1) operating at peak administrative efficiency, 2) engaging consumers, 3) shifting risk and 4) creating the clinical outcomes-driven business. (Part 1 of a two-part series.)
In the 2011 Molecular Diagnostics Special edition of ADVANCE for Administrators of the Laboratory, Matthew Zubiller, vice president of decision management at McKesson Health Solutions, discusses how labs can take a proactive role in collaborating with health plans and clinicians to keep pace with the rapid growth in molecular diagnostic testing and realize the testing opportunity. Until all parties have access to shared information about each test, the test’s relevant evidence base and utility, and the patient-specific coverage policies, labs can approximate transparency by leveraging emerging information technology in the form of clinical and financial decision support tools.
While health plan members participating in high deductible health plans may become more attuned to the costs associated with their healthcare choices, there are occasions when they should use services for acute, non-critical conditions but don’t because of the high-deductible barrier. In these instances, it makes sense to provide a free healthcare service for acute conditions that members would otherwise avoid because of cost. In this article for The Institute of HealthCare Consumerism, Naoise Colgan, vice president of Care Management Solutions, McKesson Health Solutions, explores how a targeted nurse advice program can benefit the member and the plan.