Utilization Review and Control Mechanisms: From the Blue Shield Perspective

WHEN I WAS ASKED to attend this meeting, I was very happy to accept as I had visualized a couple of pleasant days in Chicago with a nice congenial group. I was somewhat shocked, therefore, when I read the agenda, to discover that I was expected to discuss, and I quote, "various utilization and control mechanisms currently employed by Blue Shield Plans, to report their effectiveness, discuss new programs under consideration, and stages of possible plan activity which would lead to an effective program," end of quote. This would seem to imply that I am an expert in all matters of utilization. I should like to dispel that implication right now. Frankly, I don't know all that is being done by Blue Shield Plans to control overutilization. I am familiar with the program of the United Medical Service of New York and to a lesser extent that of the Michigan Medical Service. Perhaps this points up the desirability of closer liaison between Blue Shield Plans regarding these matters.