What is the goal of UM? Isn't it just more "insurance red tape?"

The key to a successful medical management program is early identification and action. UM provides the best tool for the initial identification of a patient’s entry into the health care system. This allows the ACM medical management staff to be proactive in working with patients and their providers to assure delivery of health care in the most appropriate and cost effective manner.

How does UM reduce overall health care costs for the employer and insured?

Early identification allows ACM to work directly with the patient and the provider to assure that the care is being delivered in the most appropriate and cost effective setting. UM impacts care and costs in many ways including:

• Direction to an in-network PPO provider (PPO Channeling)
• Determining the optimal length of stay (Milliman Care Guidelines), avoiding unnecessary hospital days
• Concurrent review
• Collaborative discharge planning with both the patient and provider to assure that all the patient’s health care needs are in place thereby avoiding delays in discharge and/or a readmission
• Initial identification of Case Management opportunities

Why does ACM recommend Precertification for outpatient services?

Due to advancements in medicine and the delivery of health care, many very complex and expensive treatments are now done in an outpatient setting. Precertification of outpatient services allows ACM an opportunity to impact health care costs prior to receipt of the claim when the opportunity for proactive involvement has been lost.