Utilization Management
Utilization management helps health care organizations control costs and improve quality. The principal objective of utilization management is the reduction of practice variations by establishing parameters for cost-effective use of health care resources.
For this discussion, you are taking on the role of the director of utilization management at Mount St. Clare Medical Center. Some practice variations have been observed among health care providers at your medical center. Your CEO asks you to conduct training for your health care providers.
In your initial post,
-Differentiate three basic components of utilization management as depicted in Figure 5.1 in Chapter 5 of your textbook.
-Explain the importance of drug utilization review and step therapy.
-Distinguish between disease management (DM) and case management.
-Examine a successful DM program (e.g., Aetna Health Connections disease management program) from real-life provided by an employer, hospital, health insurer, or other entity. Be sure to address its accreditation or certification status, if any, and its impacts on health care quality and cost.
Your initial post should be at least 500 words. Support your response with a minimum of two scholarly sources published in the last 5 years. Your sources must be formatted according to APA StyleLinks to an external site. as outlined in the Writing Center. The Scholarly, Peer-Reviewed, and Other Credible SourcesLinks to an external site. table offers additional guidance on appropriate source types.
