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Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
[2] [3] A failed authorization can result in a requested service being denied or in an insurance company requiring the patient to go through a separate process known as "step therapy" or "fail first." Step therapy dictates that a patient must first see unsuccessful results from a medication or service preferred by the insurance provider ...
In the United States, a health maintenance organization (HMO) is a medical insurance group that provides health services for a fixed annual fee. [1] It is an organization that provides or arranges managed care for health insurance , self-funded health care benefit plans, individuals, and other entities, acting as a liaison with health care ...
The Texas Health and Human Services Commission (HHSC) is an agency within the Texas Health and Human Services System. It was established by House Bill 2292 in 2003 during the 78th Legislature, [ 1 ] which consolidated twelve different healthcare agencies into five entities under the oversight of HHSC.
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[3] [4] Gradually, health services research increasingly examined hospital readmissions, in part as a response to rising health care costs and a recognition that certain groups of patients were high consumers of health care resources. These patients often had multiple chronic conditions and were repeatedly hospitalized to manage them.
"The system is rigged against Americans who need care, people who have health insurance, and it is largely because of the role that Wall Street plays in our health care system," he said.
Because of the calendar, Social Security recipients who get Supplemental Security Income benefits get their first 2025 check on Dec. 31, 2024.