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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 ...
A day hospital is an outpatient facility where patients attend for assessment, treatment or rehabilitation during the day and then return home or spend the night at a different facility. [1] Day hospitals are becoming a new trend in healthcare. [ 2 ]
Similarly, if the hospital spends more per patient than the national average, they would incur that difference as a loss on their balance sheet. [5] Potential Tradeoff Between Cost and Quality of Care. An additional complication when evaluating cost efficiency in healthcare is the potential tradeoff with the quality of healthcare.
Value-based health care (VBHC) is a framework for restructuring health care systems with the overarching goal of value for patients, with value defined as health outcomes per unit of costs. [1] The concept was introduced in 2006 by Michael Porter and Elizabeth Olmsted Teisberg , though implementation efforts on aspects of value-based care began ...
An estimated 80% of persons obtaining coverage under the ACA can get it for less than $75 per month after subsidies, [37] if they choose the lowest-cost "bronze" plan. The average cost for the "second-lowest cost silver plan" (the benchmark plan and one of the most popular) was $208/month after subsidy for a 40-year-old male non-smoker in 2017 ...
For scale, cutting administrative costs to peer country levels would represent roughly one-third to half the gap. A 2009 study from Price Waterhouse Coopers estimated $210 billion in savings from unnecessary billing and administrative costs, a figure that would be considerably higher in 2015 dollars. [50] Cost variation across hospital regions.
Evaluation of results for each patient & adjustment of the care plan; Evaluation of overall program effectiveness & adjustment of the program [4] In the context of a health insurer or health plan it is defined as: [5] A method of managing the provision of health care to members with high-cost medical conditions.
In the mid-1980s, it was believed that Medicare's hospital prospective payment system with diagnosis-related groups may have led to hospitals' discharging patients to post-hospital care (such as skilled nursing facilities) more quickly than was appropriate, to save money. [10]