United HealthCare surprised many in 1999 when it announced that it was doing away with utilization management. Just what the health plan subsequently did, and how it did it, has been a subject of debate. There's little doubt, however, that precertification had helped to make HMOs a convenient villain in society.
The American Accreditation HealthCare Commission, which frequently refers to itself by its old acronym, URAC, surveyed — by various means — 92 health care organizations, and discovered a definite trend away from precertification.
The exception seems to be for medications. Respondents — which included HMOs, PPOs, stand-alone medical management companies, insurance carriers, and third-party administrators — view pharmacy precertification as a growth area. Respondents said that their customers — employers, for the most part — will want to see more pharmacy precertification.
While only 33 percent of health care companies offer pharmacy precertification now, 74 percent told URAC that they expect customers to want more of it.
Closer oversight of pharmacy may be coming
SOURCE: AMERICAN ACCREDITATION HEALTHCARE COMMISSION, TRENDS IN MEDICAL MANAGEMENT: 2001 INDUSTRY PROFILE