How can physicians be better informed of available resources for utilization management and cost containment?

1 Identify the gaps and needs

The first step to improve utilization management and cost containment is to identify the gaps and needs in the current system. Physicians can conduct a self-assessment or use external audits to evaluate their performance, processes, and outcomes in relation to the standards and best practices of their specialty and setting. They can also solicit feedback from patients, colleagues, and other stakeholders to identify the areas of improvement and the challenges they face.

2 Seek relevant information and education

The second step is to seek relevant information and education on the available resources and tools for utilization management and cost containment. Physicians can access various sources of information, such as guidelines, protocols, policies, reports, databases, websites, newsletters, journals, podcasts, webinars, and courses. They can also consult with experts, peers, mentors, coaches, or consultants who can provide guidance, advice, support, or referrals. They can also join professional associations, networks, or communities of practice that can offer opportunities for learning, sharing, and collaboration.

3 Use evidence-based tools and strategies

The third step in utilization management and cost containment is to use evidence-based tools and strategies. Clinical decision support systems are software applications that provide physicians with relevant information, recommendations, alerts, or reminders based on the patient's data and the clinical guidelines. Prior authorization requires physicians to obtain approval from the payer or case manager before ordering or providing certain services or treatments. Care coordination involves communicating and collaborating with other health care providers, case managers, patients, and caregivers. Care pathways are standardized plans of care that outline goals, interventions, outcomes, and indicators for a specific patient population or condition. Utilization review involves reviewing and monitoring the utilization of services or resources by physicians or patients to ensure their appropriateness, necessity, and effectiveness.

5 Implement changes and improvements

The fifth step is to implement changes and improvements based on the findings and feedback from the previous step. Physicians can use various tools and techniques such as Plan-Do-Study-Act cycles, quality improvement projects, Lean management, and Six Sigma to plan, execute, and sustain the changes and improvements. Plan-Do-Study-Act cycles involve planning a change, testing it, studying the results, and acting on the learning. Quality improvement projects involve defining a problem, setting a goal, identifying the causes, selecting the solutions, implementing the interventions, and evaluating the outcomes. Lean management is a management approach that focuses on eliminating waste, increasing value, and optimizing flow in the health care processes and systems. Six Sigma is a management approach that focuses on reducing variation, improving quality, and enhancing customer satisfaction in the health care processes and systems.

6 Share and disseminate the knowledge and experience

The sixth step is to share and disseminate the knowledge and experience gained from the utilization management and cost containment activities. Physicians can use various channels and formats to communicate and disseminate their findings, lessons, best practices, challenges, and recommendations to their peers, colleagues, organizations, payers, case managers, patients, and other stakeholders. They can also participate in conferences, workshops, seminars, forums, or panels that can provide platforms for exchange, discussion, and learning.