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29. Digging Into My Modest Election-Year Proposal For Healthcare Reform: Part 2— Pivoting To Care Management From Our Obsession With Utilization Management

Care management/population health is a critical component of healthcare reform. I propose that America end its obsession with utilization management and prior authorization and pivot to care management and population health. Much more savings and better outcomes would result.

About The Podcast:

Millions of Americans feel confused and frustrated in their search for quality healthcare coverage.

Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change.

Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare.

Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name.

Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare.

Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America.

About The Episode:

On this episode, Marc discusses care management/population health as a critical component of healthcare reform. America must end its obsession with utilization management and prior authorization and pivot to care management and population health. Much more savings and better outcomes would result.

Key Takeaways:  

Utilization management (UM) and prior authorization (PA) is the upfront “gate” to accessing services and certain expensive locations.

While it has its role, regulations are changing in this area and America must end its obsession with UM and PA.

Care management and population health would save a great deal more and improve health outcomes.

Risks of members need to be identified and tracked, both clinical and social determinant factors.

Appropriate investments must be made in holistic care management and engagement with members and providers.

Primary care, wellness, and prevention need critical investments.

Our outcomes are much worse than other developed countries primarily because we do not make investments in care management broadly.

Cost savings and better outcomes would result if we pivot from UM to CM.

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The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance

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