5 Ways Medical Management Has Changed over the Years

Meeting of medical team to help with medical management.

Over the past several decades, medical management has been in a constant state of change. In the late 1990s, healthcare companies dismantled the aggressive type of management that had been driving fair practice in the medical field for the previous 2 decades. This ultimately left the healthcare industry unmanaged and led to skyrocketing healthcare premiums. 

The past 2 decades have been a slow but steady reinstatement of medical management that is aimed at creating a truer healthcare market for the consumer. Such an approach has demonstrated better care at a lower cost with success depending on managing all aspects of clinical and financial risk.

What Is Medical Management?

In short, medical management is an umbrella term for managing several different areas of the healthcare industry from patient to provider to ensure the process is fair and successful.

Management professionals help the patient navigate all sectors of the healthcare field—from working with them to stay on track with personal wellness goals, to managing unexpected health care needs, to coaching and offering support for chronic health concerns. 

Medical management is there not only to work with the patient but also to work with the healthcare providers to ensure the patient receives the most appropriate care in a quality, safe, timely, and cost-efficient manner.

Management strategies are designed to modify consumer and provider behavior to improve the quality and outcome of healthcare delivery while maintaining financial integrity.

5 Ways Medical Management Has Changed over the Years

1) Technology 

Medical administration and management focus on creating transparency, reducing risk, innovating healthcare, and establishing relationships between patients and clinicians. Technology has brought about the implementation of electronic medical records, addressing all of these issues as well as healthcare costs, value, and access. With complete medical records available electronically, clinicians are able to make better diagnoses. Data collection becomes more efficient, and data can be shared quickly to improve overall patient satisfaction. 

2) Healthcare Law 

Healthcare law is constantly evolving, and medical managers need to be vigilant about staying current on the legal policies that pertain to the particular practice or provider they are managing. Management professionals will be required to know the constant changes that are being voted on and follow those outcomes. Healthcare law is largely determined by the current political climate, leaving it open to frequent changes.  

3) Virtual Healthcare

Very few people really enjoy going to the doctor, which causes some to wait until a condition worsens before seeking care. This mind-set drives up costs, including expenses related to ER visits. Virtual health is a way that patients communicate directly with caregivers. This technology can help physicians see more patients by creating a comfortable setting for the patient as well as encouraging the patient to take a greater role in their own care. Medical management will be instrumental in determining when/if physicians and other caregivers should be at the site of care delivery and when their work can be performed virtually. 

4) Expansion of Medicare Advantage 

Because of the substantially increasing number of Medicare Advantage beneficiaries, healthcare managers, physicians, and providers need to reassess their relationships with Medicare Advantage plans. Even though Medicare Advantage reimburses at a lower rate than traditional Medicare, these plans account for the coverage of more than one-third of all Medicare beneficiaries. This means that even though reimbursement levels are lower, the volume of patients could make up the difference.

5) More Accessible Healthcare

In an effort to keep up with the rigors of technology, the skyrocketing costs of pharmaceuticals, and increased deductibles, providers have begun to offer a number of for-profit healthcare alternatives, such as digital and remote pharmacy solutions, ambulatory health care centers, urgent care centers, physical therapy, and physician practices. This can help keep costs down and could greatly affect the infrastructure of traditional hospital care and those who manage the programs and facilities.

What You Can Look Forward to in the Future of Medical Management

Medical management is more than just clinical management. The future of it will continue to be vital to healthcare. 

Healthcare businesses now depend on delivering excessive services, often with flagrant pricing, to maintain the revenues they have come to expect. However, that practice doesn’t benefit the patient. Therefore, it is a balancing act, with each sector of the industry having developed different ways to address care and cost, which makes a medical manager a necessary asset

Managing the processes of the medical field requires knowing where healthcare waste is buried and going after it. It demands fluency in risk, analytics, medical/surgical and drug claims data, evidence-based guidelines, clinical decision support, appropriate cost, and purchasing and negotiation. 

The tools and skills needed to identify and address all of the facets of the medical field are complex, and the job itself is heavy lifting. That said, we now have far better data and information management tools than were available a decade ago. There is also much easier access to educational tools to keep medical management professionals up to speed when new technology and systems are available.

Conclusion

Change is constant. Medical management is a complex and ever-evolving field. Managers who can understand and adapt to changes in technology, policy, and patient populations will find themselves better able to make informed decisions that benefit all parties, making themselves a valuable asset to any business seeking management.


Practice Management is challenging enough without our own self-made problems. Learn more about AAMM’s seminars and resources.

Roger Bonds is the founder of the American Academy of Medical Management and president of The National Institute of Physician Recruitment & Retention, based in Atlanta, GA. Find AAMM on FacebookLinkedIn, Twitter, and YouTube. Email AAMM at [email protected], or call their main office at 770-649-7150.