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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 ...
In business, the utilization rate is an important number for firms that charge their time to clients and for those that need to maximize the productive time of their employees. It can reflect the billing efficiency or the overall productive use of an individual or a firm.
The generic model used in the United States is the chronic care model, which holds that health care does not only involve change in the patient and that high-quality disease care counts the community, the health system, self-management support, delivery system design, decision support, and clinical information systems as important elements in ...
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.
According to a study paid for by America's Health Insurance Plans (a Washington lobbyist for the health insurance industry) and carried out by PriceWaterhouseCoopers, increased utilization is the primary driver of rising healthcare costs in the US [143] The study cites numerous causes of increased utilization, including rising consumer demand ...
Overall labor effectiveness (OLE) is a key performance indicator (KPI) that measures the utilization, performance, and quality of the workforce and its impact on productivity. Similar to overall equipment effectiveness (OEE), OLE measures availability, performance, and quality.
Physicians and other health care providers lack the necessary actuarial, underwriting, accounting and finance skills for insurance risk management, but their most severe problem is the greater variation in their estimates of the average patient cost, which leaves them at a financial disadvantage as compared to insurers whose estimates are far ...
Taken together, HDHPs should decrease health care utilization and stem the increase in national health care costs. Success of this theory depends on ability of patients to make informed decisions on their health care purchase [ 30 ] similar to what they do for goods and services. [ 31 ]