Which statement best describes utilization-management techniques used to contain health plan costs?

Which statement best describes utilization-management techniques used to contain health plan costs?

• A. Premium reductions, extended warranty for devices, and discount cards.
• B. Preauthorization, step therapy, and provider networks along with utilization review.
• C. Health savings account, dependent care, and flexible spending.
• D. Employee satisfaction surveys, training, retirement planning.

Answer: (B)

Utilization management aims to ensure that care is medically necessary, appropriate, and delivered in a cost-efficient way. The best description includes preauthorization, which requires approval before certain services to prevent unnecessary procedures; step therapy, which encourages starting with lower-cost, evidence-based options before more expensive ones; provider networks, which steer care to contracted providers to secure lower rates and standardized quality; and utilization review, which continually assesses the necessity and efficiency of care as it happens. Together, these tools control plan costs by reducing waste, promoting appropriate care pathways, and negotiating favorable provider terms. The other options don’t describe utilization-management techniques: they cover financial accounts, discount tools, or general HR activities rather than mechanisms that manage the use of health care services.

Utilization management aims to ensure that care is medically necessary, appropriate, and delivered in a cost-efficient way. The best description includes preauthorization, which requires approval before certain services to prevent unnecessary procedures; step therapy, which encourages starting with lower-cost, evidence-based options before more expensive ones; provider networks, which steer care to contracted providers to secure lower rates and standardized quality; and utilization review, which continually assesses the necessity and efficiency of care as it happens. Together, these tools control plan costs by reducing waste, promoting appropriate care pathways, and negotiating favorable provider terms. The other options don’t describe utilization-management techniques: they cover financial accounts, discount tools, or general HR activities rather than mechanisms that manage the use of health care services.