Utilization review and Utilization management in health care

Utilization review and Utilization management in health care

This is an assignment that focuses on the utilization review and Utilization management in health care. The paper also explains the roles of each method in survival.

The utilization review and Utilization management in health care

Assignment Overview:

Firstly, with the consistently rising costs of health care services, utilization management and utilization review are routinely used in the vast majority of current health care settings. How are they evolving over time, and what is involved in these processes? What do health care managers need to be aware of as the processes play out? In the absence of sweeping policy change (or the complete restructuring of the United States health care system), utilization management and utilization review are much more moderate processes to attempt to preserve the quality of care provided while controlling overall health care expenditures. Let’s learn a bit about each of these processes, and how they are implemented in our current health care environment.

Assignment: Using the information in the required readings as well as some additional research in peer reviewed sources, complete your Case Assignment by answering the following:

1. Firstly, compare and contrast utilization review and utilization management in health care. What are the similarities and the differences between each type of assessment? (Hint: One is generally a prospective process, and the other is generally a retrospective process).

2. Secondly, explain the specific role of each method in providing value-based health care. Who benefits from the method—the health care system, the insurance company, and/or the patient?

3. Thirdly, articulate how individual case management is critical to a hospital’s long-term survival. In what way does this practice protect your patients while keeping your doors open for business?

4. Fourthly, what are the ethical pitfalls to be aware of in performing these‌‌‍‌‌‍‍‍‌‍‍‌‍‍‍‌‌‌‍ types of quality reviews? What must health care managers be aware of in terms of ethical pitfalls and also potential unintended negative consequences?

Learning Outcomes:

Compare and also contrast utilization review and utilization management in health care. – Investigate the specific roles of utilization management methods in providing value-based health care. – Articulate how utilization management is critical to a hospital’s long-term survival.

Then, discuss ethical pitfalls—including unintended consequences—that managers should be aware of in utilization management. Background References (Use at least 2 references with other peer reviewed references): Baker, J. (2018). Improving quality of care through utilization management [Video file]. Retrieved from https://youtu.be/g-T-YeP53nY Carasso, S. (2017). However, is that test necessary? The key to laboratory utilization management. The Journal of Medical Practice Management: MPM, 33(3), 160-164. Desai, S., Gruber, P. F., Eiting, E., Seabury, S. A., Mack, W. J., Voyageur, C., . . . Terp, S. (2017).

Lastly, the effect of utilization review on emergency department operations. Annals of Emergency Medicine, 70(5), 623-631.e1. El-Othmani, M. M., Sayeed, Z., Ramsey, J. A., Abaab, L., Little, B. E., & Saleh, K. J. (2019). The joint utilization management program: Implementation of a bundle payment model and also a comparison between year 1 and 2 results. The Journal of Arthroplasty, 34(11), 2532-2537. Parast, M. M., & Golmohammadi, D. (2019).