Influencing Behaviors Through Managed Care

Examples of health promotion initiatives:   gym membership discounts, healthy meals plans, employee newsletters, smoking cessation programs

Utilization Review (UR)-
  •  review of the services delivered by a health care provider to evaluate the appropriateness, need, and quality of the prescribed services.
  • Guards against unacceptable variation (not necessarily creative methods) in medical or pharmacy practice and against over-usage (or inappropriate usage) of services
  • Insurance will lay out which services are electives within their plan
  • Must get 2nd opinion before an elective surgery
  • MC has a group of preferred providers who patients are given financial incentive to go to
  • Doctors will discount their services in exchange for a higher volume of patients

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