There are a number of possible approaches to the challenges of rising utilization and rising costs:

1. Controlling utilization—the supply. In theory, healthcare costs can be reduced through "managing utilization"-to get a handle on, reduce, or eliminate the inappropriate use of healthcare services. But, it's a tough process. Expectations are high, and the consequences dire. Deprived of the ability to control costs through utilization management, some employers are cutting their healthcare expenditures by dropping employee health insurance. The consequence: the cost of caring for these uninsured employees shifts to other government payers or private payers.

2. Promoting prevention—the demand. By reducing the demand for healthcare, the existing supply of health resources is more available to those in need. We see prevention efforts in a lot of areas:

    a. Public health. E.g., Intermountain supports programs to enhance access to mental health services, increase seat-belt use, and increase immunization rates.

    b. Between doctor and patient. E.g., physicians and care managers help chronically ill patients manage their diseases and maintain or improve their health status.

    c. Between health plan and member. The relationship between a health plan and the population of its members can be a valuable platform to promote health and encourage prevention.

    d. Research laboratories. Eventually, medical science may allow caregivers to prevent the onset of disease even before symptoms occur, through new diagnostic techniques and therapies. Breakthroughs in genetic testing and interventions are very promising.

3. Increasing productivity. By sharing best medical practices and finding the best ways to provide care, we have increased productivity even as we improve the quality of the care we provide.

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