Becker's Healthcare November 25, 2025
The American College of Physicians published recommendations for managed care Nov. 25 in the group’s flagship journal, Annals of Internal Medicine.
Managed care plans, like HMOs and PPOs, are insurance models that focus on mitigating costs and utilization while maintaining quality. They rely on contracted provider networks.
Here are highlights from the 13 recommendations:
1. Utilization management practices “must only encourage high-value, evidence-based and patient-centered care.”
2. Utilization management should align with physician guidance.
3. Utilization management criteria should be disclosed.
4. Health plans should reduce administrative burden with utilization review.
5. Patients and physicians can override or appeal utilization management decisions in a streamlined manner.
6. The institution of qualitative and quantitative network adequacy standards is encouraged. Health plans...
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