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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 ...
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.
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 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.
HCUP Logo. The Healthcare Cost and Utilization Project (HCUP, pronounced "H-Cup") is a family of healthcare databases and related software tools and products from the United States that is developed through a Federal-State-Industry partnership and sponsored by the Agency for Healthcare Research and Quality (AHRQ).
Healthcare utilization outcomes for patients experiencing poor transitional care include returning to the emergency room or being admitted to the hospital. As healthcare expenditures rise at an unsustainable rate, there is increasing focus by patients, providers, and policymakers on restraining unnecessary resource utilization such as that ...
Image source: The Motley Fool. UnitedHealth Group (NYSE: UNH) Q3 2024 Earnings Call Oct 15, 2024, 8:45 a.m. ET. Contents: Prepared Remarks. Questions and Answers. Call Participants
URAC's accreditation programs include specialty pharmacy, digital health, utilization management, health plan, case management, and others. [4] In order to earn an accreditation, organizations submit various policies and procedures which are reviewed by a nurse or pharmacist and then the Accreditation Committee. [5] Accreditation lasts for ...
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