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Description of Medical Management Metrics

No functional aera has been subject to greater controversy than medical management. On one hand, while the efficacy of specific medical management techniques may be debated, the fact is that in the prudent judgment of many health plans, spending money on medical management  reduces costs and enhances quality for health plan members. On the other hand, even the accounting treatment of these activities is a focus of health policy under health care reform.

In most universes, a separate volume, II.B analyzes the administrative expenses associated with medical management.  We provide detailed metrics concerning such sub-functions as precertification and recertification, case management, disease management, nurse information line, utilization review and appeals and quality assurance and wellness.

Sample Table of Contents

Among the metrics provided include the propensity to employ various medical management strategies, practice categories for case or disease management (e.g., diabetes, asthma, COPD, CAD), the propensity for plans to outsource various medical management activities and practice categories and pathways of administering medical management functions.

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