“The only way to win is to work together,” advises Holly Toomey, RN, BS, HCA, director, product management at McKesson Health Solutions. Her recent blog post features practical advice for payers and providers navigating the new reality of healthcare: success requires the best possible clinical outcomes at the lowest possible costs.
To build a more comprehensive, collaborative relationship between payers and providers, Toomey suggests:
- An Automated Utilization Management Process – Use electronic tools to streamline requests for treatment, minimizing patient delays and making it easier to exchange clinical and financial information in real time.
- A Shared Exception-Based Utilization Management System – Set up transparent, mutually-agreed-to business rules that fast-track the approval of medical treatments that are already routinely approved.
- A Flexible Collaboration Process – Make evidence-based clinical guidelines part of this new utilization management system to keep you all aligned to the evidence and on track for the best care outcomes.