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Utilization management

Index Utilization management

Utilization Management (UM) is the use of techniques that allow purchasers to manage the cost of health care benefits by assessing its appropriateness before it is provided using evidence-based criteria or guidelines. [1]

13 relations: Advertising Age, Avedis Donabedian, Case management (US health system), Donabedian model, Evidence-based medicine, Health care, Health insurance, Managed care, Medical necessity, National Academy of Medicine, Patient, Peer review, Registered nurse.

Advertising Age

Ad Age (or Advertising Age) is a global media brand publishing analysis, news and data on marketing and media.

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Avedis Donabedian

Avedis Donabedian (7 January 1919 – 9 November 2000) was a physician and founder of the study of quality in health care and medical outcomes research, most famously as a creator of The Donabedian Model of care.

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Case management (US health system)

Case management is a managed care technique within the health care coverage system of the United States.

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Donabedian model

The Donabedian model is a conceptual model that provides a framework for examining health services and evaluating quality of health care.

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Evidence-based medicine

Evidence-based medicine (EBM) is an approach to medical practice intended to optimize decision-making by emphasizing the use of evidence from well-designed and well-conducted research.

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Health care

Health care or healthcare is the maintenance or improvement of health via the prevention, diagnosis, and treatment of disease, illness, injury, and other physical and mental impairments in human beings.

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Health insurance

Health insurance is insurance that covers the whole or a part of the risk of a person incurring medical expenses, spreading the risk over a large number of persons.

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Managed care

The term "managed care" or "managed healthcare" is used in the United States to describe a group of activities ostensibly intended to reduce the cost of providing for profit health care while improving the quality of that care ("managed care techniques").

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Medical necessity

Medical necessity is a United States legal doctrine, related to activities which may be justified as reasonable, necessary, and/or appropriate, based on evidence-based clinical standards of care.

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National Academy of Medicine

The National Academy of Medicine (NAM), formerly called the Institute of Medicine (IoM), is an American nonprofit, non-governmental organization.

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Patient

A patient is any recipient of health care services.

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Peer review

Peer review is the evaluation of work by one or more people of similar competence to the producers of the work (peers).

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Registered nurse

A Registered Nurse (RN) is a nurse who has graduated from a nursing program and met the requirements outlined by a country, state, province or similar licensing body to obtain a nursing license.

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Utilization review.

References

[1] https://en.wikipedia.org/wiki/Utilization_management

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