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Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers, particularly health insurance companies, to manage the cost of health care benefits by assessing its medical appropriateness before it is provided, by using evidence-based criteria or guidelines.
Molina Healthcare was founded in 1980 by C. David Molina, an emergency room physician in Long Beach, California. [4] He had seen an influx of patients using the emergency room for common illnesses such as a sore throat or the flu because they were being turned away by doctors who would not accept Medi-Cal.
In 2019, MA operators denied 13% of prior authorization requests that would have been accepted under traditional Medicare. [17] In 2019 alone, MA plans cost tax-payers $9 billion more than if those enrollees were in traditional Medicare.
The earliest form of HMOs can be seen in a number of "prepaid health plans". In 1910, the Western Clinic in Tacoma, Washington offered lumber mill owners and their employees certain medical services from its providers for a premium of $0.50 per member per month.
Prior to his leadership roles at the firm, Molina held a number of other key roles at Molina Healthcare. These included: Medical Director (supervising medical and risk management matters) and vice president (in charge of provider contracting, member services, marketing and QA).
Regulators believe it will improve medication adherence because it has to be taken just once every two months, and it will also widen adoption as it eliminates the need to hide pills or pharmacy visits for discretion. [5] In its 2021 guidelines, the World Health Organization (WHO) recommends multiple forms of PrEP for HIV prevention: [6]
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