Do cm interventions affect health care utilization?
These findings represent a high level of evidence of the impact CM interventions have on health care utilization for individuals with chronic illnesses. The evidence presented in this review suggests that CM interventions favorably affect health care utilization outcomes in chronic illness care.
How does utilization management improve care?
Here is another example of how utilization management improves care: A hospital admits a heart attack patient after they have been stabilized in the ER. The hospital contacts the patient’s insurance provider and they discuss the options for treatment and the optimal length of stay. The insurance provider checks in for progress reports regularly.
What is the difference between utilization review & um?
The two terms are occasionally used as synonyms. Utilization review (UR) is a process in which patient records are reviewed for accuracy and completion of treatment, after the treatment is complete. UR, a separate activity, can be a part of UM (specifically during retrospective review), and can drive changes to the UM process.
What are the health care utilization outcomes of case management interventions?
Results are synthesized from seven English language systematic reviews published between January 1990 and June 2017. Hospital readmissions, length of hospital stay, institutionalization, emergency department visits, and hospitals/primary care visits were all identified as health care utilization outcomes of case management interventions.
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Oct 9, 2013 · discharge planning, appropriate referral to case management and assure that medical decisions will not be unduly influenced by fiscal and Provide utilization management data for the provider re credentialing interpretation used in making the determination review and discussion by the members
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