Utilization Management
The principal objective of utilization management is the reduction of practice variations by establishing parameters for cost-effective use of health care resources. There are four main techniques or tools used in utilization management: demand management, utilization review, case management, and disease management. Utilization management helps MCOs control costs and improve quality.
- What are the challenges faced by MCOs regarding practice variations? What do you think can be done to meet these challenges?
- Differentiate between the three main processes of institutional utilization management.
- Determine the main purposes of each process of institutional utilization management? Which process do you think is the most important, and why?
- Explain the functions of the utilization management nurse, and compare and contrast the information from that organization.
- Explain your understanding of disease management and case management. What in your opinion are one major similarity and one major difference between the two types of management?