Dr. Skip's Medical Peer Review Blog: Cost Pressures on Healthcare

Saturday, September 09, 2006

Cost Pressures on Healthcare

Like everyone else today, cases managers and health care professionals are being pressured to reduce costs and eliminate treatments wherever possible in order to control the double-digit increases in healthcare costs across the nation.

How can you as a case management or utilization review professional be sure that you’re reducing cost while still effectively ensuring that patients and members of your health plan consistently get what they're supposed to?. One of the most common solutions for this today is to bring in external medical review resources to look at cases that are either very complex or that require a specialist’s review before making a final decision.

Do you have specialists available to your organization to perform these reviews? If you do, you're among the few because most organizations today can't afford to employ or retain advanced physician specialists. For those case managers and utilization review nurses who don't have those kinds of specialist resources at their disposal, the best answer is to outsource those cases to an Independent Review Organization.

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