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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 ...
Medical necessity is a legal doctrine in the United States related to activities that may be justified as reasonable, necessary, and/or appropriate based on evidence-based clinical standards of care. In contrast, unnecessary health care lacks such justification. Other countries may have medical doctrines or legal rules covering broadly similar ...
As a result, care coordination includes traditional mental health services but may also encompass primary healthcare, housing, transportation, employment, social relationships, and community participation. In the 1940s, this was known as social counseling. [3] It is the link between the client and care delivery system. [2]
Primary care has often been termed the de facto mental health system in the United States. [7] Research shows that approximately half of all mental health care services are provided solely by primary care providers. [8] Furthermore, primary care practitioners prescribe about 70% of all psychotropic medications and 80% of antidepressants. [9]
Behavioral health outcome management (BHOM) involves the use of behavioral health outcome measurement data to help guide and inform the treatment of each individual patient. Like blood pressure, cholesterol and other routine lab work that helps to guide and inform general medical practice, the use of routine measurement in behavioral health is ...
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.
A Certified Community Behavioral Health Clinic (CCBHC) is a type of health clinic in the United States that treats mental health and substance abuse disorders regardless of the patient's health insurance status and ability to pay for care. [1] [2] [3] CCBHCs are funded through Medicaid or SAMHSA grants. [2] [4]
Among the many areas of practice represented in the CARF standards are aging services; behavioral health, which replaces institutional behavior management; psychosocial rehabilitation; child and youth services (with younger and established family services and support); durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS ...