Effective governance structure and management of utilization programs

Abstract

The operation of an effective utilization management program requires a governance structure that aligns both institutional and institution-wide goals and activities. It has been estimated that as much as 30 % of laboratory testing is likely to be wasteful. The prospect of broadly applied personalized or precision medicine holds great promise but with the attendant risk that, if misapplied, there is potential for extraordinary waste. As a vehicle for exploring the relationship between governance structure and effectiveness, this chapter outlines the four-phase evolution of laboratory utilization management in a large academic medical center (University of Michigan Health System). The consideration of failed early efforts and much more successful recent efforts illustrates the fundamental importance of alignment of governance in effective management of pathology and laboratory utilization.