Health plans are struggling to remain viable and competitive, seeking new ways to swiftly reduce and hold down cost without compromising quality or satisfaction.
UMM prides itself on the expertise and specialty knowledge of our clinical team. Our chief medical director works continuously to review peer-to-peer consults, medical necessities protocols, and quality assurance programs. Expert knowledge and experienced medical specialist sets UMM apart from our competitors. By providing expert review coupled with evidence-based guidelines, we enable our clients the ability to manage complex cases in the most appropriate and cost effective manner.
UMM understands the healthcare system is under immense pressure and increase financial risks. Our effective Medical Necessity Review (MNR) or Utilization Management (UM) and clinical protocols continuous promote quality improvement by following national evidence-based guidelines to establish medical necessity of medical services while
Healthcare providers and members benefit because the review ensures members receive appropriate services at the right time and for the right duration of time. MNR and UM reduces the number of unnecessary office visits, modalities and procedures; thus, resulting in a tremendous cost savings for health plans.
- Clinical evidence
- Credible, published, scientific evidence supported by controlled clinical trials or observational studies
- Rigorous and consistent clinical management of:
- Clinical effectiveness - Treatment of injury or symptom must be proven to be clinically effective
- Clinical appropriateness - Type, frequency, extent and duration must be appropriate for the individual patient
- Cost effectiveness - Services must reduce more costly services such as surgeries and physician procedures
UMM recognizes that each organization we work with is unique. It is our client centric approach that has allowed us to create and develop new and existing programs with great success. With the new healthcare reform laws, we look forward to continuing to partner with payors, third party administrators, medical management organizations, health plans and government organizations to ensure compliance, quality of care and cost effective solutions.