As healthcare moves toward the full embrace of value-based care models, utilization management is increasingly leveraged as a means to not only manage costs but to ensure quality and manage risk as well.

A combination of technological advancements and increasing clinical evidence has created a clearer understanding of how much the environment in which people are born, grow, live, work and age impacts their health.

Population health initiatives typically assume that members can participate in their own care on a basic level, yet those assumptions may not hold true for Medicare and Medicaid members. Their lives typically differ from the lives of those with commercial insurance, which makes cost-effective care management uniquely challenging—and even more important.