As employers look to control health care costs, MCOs have implemented utilization review protocols to ensure the right care is provided to patients at the right time. At the same time, employers, regulatory agencies, and accreditation organizations have increased their expectations that the quality of care increases for patients receiving care through the MCO.
1. Define the key elements of utilization review and quality management.
2. Compare and contrast these two functions and how they have changed over time.
3. What role does each of these play in managed care?
4. Do these functions add value to managed care?