The new paradigm for employers in healthcare cost management includes a refusal to abdicate responsibility to insurance companies and other vendors (think disease management, case management, wellness, health promotion, etc.).
Employers need an independent assessment of health risks within their insured population and a partnership with a firm that will ensure that all healthplan members are getting the support they need from medical management.
Proactive healthplan sponsors don’t assume that all at-risk members are being medically managed; instead, they deploy knowledgeable, experienced clinicians to present all identified (and suspected) health risks to the carrier’s medical management team and then they monitor the progress and outcomes.
That’s a process we call Medical Management Oversight (MeMO)™. and it’s essential to controlling healthcare costs.