Homework: Utilization Review and Quality Management
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.
In no less than 4 and no more than 6 pages, write a paper that addresses the following:
1. Define the key elements in 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? Be sure to think about this from employers who offer coverage to their employees; to regulatory agencies who provide oversight; and to private organizations that conduct external reviews.
4. In your opinion, do these functions add value to managed care? Support your opinions with examples and your research.
Format your homework according to the give formatting requirements:
1. The answer must be double spaced, typed, using Times New Roman font (size 12), with one-inch margins on all sides.
2. The response also includes a cover page containing the title of the homework, the course title, the student's name, and the date. The cover page is not included in the required page length.
3. Also include a reference page. The references and Citations should follow APA format. The reference page is not included in the required page length.