Health care cost containment: how Pittsburgh is addressing the challenge

Rapidly escalating health care costs have the public and private sectors searching for methods to provide health care benefits in a more efficient manner. Efforts have also been underway at the community level with the development of health care coalitions created to build consensus toward a fair solution for all parties affected. With the assistance of the Robert Wood Johnson Foundation and many local co-sponsors, the Pittsburgh Program for Affordable Health Care (PPAHC) was organized to address health care cost containment issues in the greater Pittsburgh area. One of the means by which PPAHC chose to achieve this was through the development of a Model Utilization Management Program. This is a document containing community-sanctioned administrative and clinical standards for utilization review which take into consideration the needs and concerns of providers, purchasers, and consumers, and which have a goal of reducing medically unnecessary inpatient hospitalization while concurrently maintaining quality of and access to care. This article describes both the process and the product of PPAHC's efforts toward health care cost containment in Pittsburgh, specifically focusing on its utilization management component.