There may be plenty of reasons why teams and leagues have trouble with cost control, though weak-kneed management that tends to buckle under these kinds of ultimatums are certainly a big one.

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Rather, take an aggressive stance on liability--on what you're responsible for and how you can control it--and the effect on cost management will be tremendous.

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"The existing deficiencies in management structure, institutional culture, cost estimating and program control must be acknowledged and corrected for the program to move forward in a credible fashion, " it said.

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But in the commercially insured population, the program led to a net medical cost decrease of 22% compared to a control group not using the care-management services.

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