Utilization Management

Medicine has become goal-based with well-defined indicators of success, and pay-for-performance will become the norm. To achieve this goal, not only good documentation and compliance are needed, but also a system that focuses on:

• Team Work

• Constant self-evaluation and assessment

• Data collection

• Analyses

• Score-keeping

In short, Health Care will become like baseball. Scores will need to be kept. Providers will need to be compared. Data will need to be trended. Organizations will have to learn to synthesize data to make sense of it. At the end of the day, the leaders in every organization, whether they run an ACO, a Medical Home, or belong to an HMO, must be forced to form parameters to measure their performance. This trend toward utilization management brings us back to forming accountability in the system.