The Learning Table: Reconciling the ER Visit

Patients need the right care at the right cost. Utilization management nurses ensure members receive appropriate services based on evidence-based practices.

Management services organizations (MSOs) relieve administrative burdens and improve quality metrics for providers. But payers benefit too.

Hospital readmission is costly and often leads to poor outcomes and even higher risk of mortality. Transitional care management aims to reduce readmission and improve patient outcomes.