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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 ...
The Andersen healthcare utilization model is a conceptual model aimed at demonstrating the factors that lead to the use of health services. According to the model, the usage of health services (including inpatient care, physician visits, dental care etc.) is determined by three dynamics: predisposing factors, enabling factors, and need.
If the PPO plan is an 80% coinsurance plan with a $1,000 deductible, the patient pays 100% of the allowed provider fee up to $1,000. The insurer will pay 80% of the other fees, and the patient will pay the remaining 20%. Charges above the allowed amount are not payable by the patient or insurer but written off as a discount by the physician.
The Case Management process encompasses communication and facilitates care along a continuum through effective resource coordination. The goals of Case Management include the achievement of optimal health, access to care and appropriate utilization of resources, balanced with the patient's right to self determination.
The only factor involved in hydrotherapy was water. A patient with a physical disability would be completely submerged in water. The theory was the cold water drew the blood out of the diseased part of the body, curing the patient. [33] This specific treatment was typically used to treat skin conditions as well as infected amputations [34]
Rates of NAS per 1,000 newborn hospitalizations are presented overall as well as by sex, expected payer, community-level income, and patient location. Hurricane Impact on Hospital Use. This new topic provides historical inpatient and treat-and-release emergency department utilization information from 11 U.S. hurricanes between 2005 and 2017.
Representative locations include (but are not limited to) hospitals, sub-acute and post-acute nursing homes, the patient’s home, primary and specialty care offices, and long-term care facilities. Transitional care is based on a comprehensive plan of care and the availability of health care practitioners who are well-trained in chronic care ...
Assertive community treatment (ACT) is an intensive and highly integrated approach for community mental health service delivery. [1] ACT teams serve individuals who have been diagnosed with serious and persistent forms of mental illness, predominantly but not exclusively the schizophrenia spectrum disorders.