Utilization management in the changing health-care environment

US health-care costs are growing at an alarming rate. "Value-based" payment models that hold providers accountable for outcomes and costs of care are becoming more prevalent. In these arrangements, provider groups will be accountable for the costs of lab tests, many of which have traditionally been revenue-generating. "Stewardship" programs aimed at newer, high-cost specialized tests, decision support on more routine tests, variation reporting, and incentives are familiar tactics that will need to be deployed in this new context. (C) 2013 Elsevier B.V. All rights reserved.