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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 ...
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 ...
This task force considered that drug utilization review was potential but this review should be evaluated and need valid evidence to put into effect. [7] In 1970, Drug utilization review program was carried out by a private pharmaceutical management company. It focused on the cost of another program. [7]
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).
Unnecessary health care (overutilization, overuse, or overtreatment) is health care provided with a higher volume or cost than is appropriate. [1] In the United States, where health care costs are the highest as a percentage of GDP, overuse was the predominant factor in its expense, accounting for about a third of its health care spending ($750 billion out of $2.6 trillion) in 2012.
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.
The Mountaineers took a step back in 2024 after a 9-4 campaign in 2023. Last season was the first time West Virginia had won more than six games in a season during his tenure.
These physicians are contracted by an independent review organization, medical management companies, third party administrators (TPAs) or utilization review companies to provide objective, unbiased determinations on what the root cause of the treatment was, whether there is medical necessity, if there was a sentinel event, what was the reason ...