The Importance of Utilization Management in Modern Medicine

A medical director manager or utilization management at Cigna, Pachavit Kasemsap, M.D. is involved with several activities related to making healthcare processes more efficient. Dr. Pachavit Kasemsap performs reviews and identifies opportunities for program improvements.

While utilization management has been a part of healthcare for a few decades, the practice of measuring the efficiency and cost-savings of healthcare has become very relevant in recent times, especially when advances in the industry have created new pathways. Utilization management encompasses all of the activities associated with evaluating the appropriateness, necessity, and efficiency of services provided to patients.

One of the ways the utilization management has improved healthcare is by making sure organizations comply with industry and legal mandates. In more recent times, utilization management teams have proven vital in assisting healthcare providers with adapting to changes in the market and to the new regulations that govern these changes. More importantly, utilization management has facilitated the more efficient use of resources. This is done through the strategic deployment of people, processes, and technology.

Finally, in a healthcare environment that relies increasingly on value-based healthcare, utilization management is important in measuring cost and quality and managing risk. Every time a patient is provided healthcare, utilization management measures the care given to the person against national, evidenced-based standards to make sure the care provided for the patient’s unique situation is appropriate and necessary.

Frequently Asked Questions about Bariatric Surgery

Pachavit Kasemsap, MD, is a general surgeon and a Healthcare Manager for Cigna. Experienced in bariatric surgery, Dr. Pachavit Kasemsap has performed more than 3,000 such procedures.

Here are answers to some of the most common questions about bariatric surgery:

Question: What is laparoscopic bariatric surgery?

Answer: Also called gastric bypass, this surgery involves a series of small incisions across the abdomen in which a small scope can be inserted along with small surgical tools. The surgeon uses these tools to staple a portion of the stomach, reducing its overall volume. A section of the small intestine is then attached to the lower stomach.

Q: Is bariatric surgery safe?

A: Any surgical procedure has risks, but the risks associated with this surgery may outweigh the risks of obesity, depending upon the patient and his/her health conditions.

Q: How long is the recovery process?

A: Most patients recover sufficiently to return to normal activities in a few weeks. However, patients may experience periods of low energy after the surgery.

About AAPL's Journal of Medical Practice Management

Pennsylvania physician Pachavit Kasemsap, MD serves as a medical director and manager in Utilization Management at Cigna, which focuses on assessing efficacy in health care practices. Dr. Pachavit Kasemsap is also a member of the professional organization of the American Association for Physician Leadership (AAPL).

The American Association for Physician Leadership aims to provide physicians with the necessary tools, such as education, career development, and thought leadership, so that they might become leaders within their professional communities. AAPL publishes The Journal of Medical Practice Management, to serve as a resource for physicians trying to build their practice.

The journal’s focus is on publishing articles related to healthcare management, whether it involves coding, healthcare administration, marketing, physician recruitment, employment law, HIPAA, and other important parts of management. Those who hope to manage healthcare organizations in academia, hospital, or private practice can gain insights from the experts who contribute to the journal.

The topics are diverse but mostly cover the economic landscape of modern healthcare. For instance, mounting overhead costs, fees, and income limitations are all topics covered in the journal.

Medicare Coverage Based on ESRD Treatment

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The recipient of an MD from the Washington University School of Medicine, Dr. Pachavit Kasemsap is a former senior medical director at Highmark Inc. While working at Highmark, Dr. Pachavit Kasemsap pursued additional revenue for MA members with ESRD from the Centers for Medicare & Medicaid Services.

A medical condition in which the kidneys cease to function on a permanent basis, ESRD, also known as end-stage renal disease or chronic kidney disease stage 6, is a chronic renal failure that requires a constant course or long-term dialysis or a kidney transplant to save the life the patient. Based on ESRD, many patients may become entitled to Medicare coverage. Medicare is a secondary group health plan payer for individuals entitled to Medicare coverage based on ESRD for a period of 30 months regardless of whether the coverage is based on employment status.

Medicare coverage can begin at various stages. For example, Medicare-covered treatments can start in the first month of dialysis if the beneficiary participates in a home dialysis training program in any Medicare-approved training facility. Medicare treatment can also begin when the patient attends home dialysis training before the third month of the dialysis or when the beneficiary is about to complete home dialysis training and start self-dialysis treatment. Also, Medicare coverage can start at the month a beneficiary is admitted to any Medicare-approved hospital for a kidney transplant or health services required prior to the transplant, or two months before the transplant if the transplant is delayed after the beneficiary is admitted to the hospital.

If the Medicare care coverage is based on ESRD only, it is expected to end 12 months after the beneficiary stops getting dialysis treatments, or 36 months after the beneficiary undergoes a kidney transplant.