value of utilization management


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value of utilization management

Paper instructions:
The value of utilization management and review has been debated among the leaders in health care since its inception. For this module’s case assignment, you are going to engage in the review of a utilization management plan for a health care organization.

Search the internet for a hospital or other health care organization’s utilization management plan. Once you have found one, WRITE 4 PAGES paper in which you address the following:

Identify the organization you researched and include the URL for the page of the utilization management plan that you examined.

Provide an overview of the organizations utilization management plan- specifically, discuss each of the elements of the plan and describe how each of the elements contributes to health care quality.

Identify two weaknesses of the organizations utilization management plan and describe “why” you consider them to be weaknesses. Postulate ways in which the weaknesses can be overcome.
PLEASE REMEMBER TO USE 4-6 Scholarly, peer-reviewed sources, NO INTERNET SOURCES. USE READING LIST BELOW

FOR THE SECOND PART:

evaluate and critique a health care facility you are familiar with and compare it to the general principles and standards for quality assurance presented in this course.

In the earlier modules you identified a health care facility for the subject of the paper and presented a description of the facility and it’s quality assurance program. You also critiqued the facility’s Continuous Quality Improvement program.

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In 4 PAGES you will discuss and critique the subject facility’s Utilization Management program.

Describe and discuss the facility’s Utilization Management program.
Compare and critique the subject facility’s Utilization Management program to that of a model facility and whether the facility adheres to the recognized standard for utilization management, including utilization review and whether this review leads to improvement in the quality of care.

Identify areas for improvement in the facility’s Utilization management program, if any, and any recommendations you think should be implemented to improve the quality of patient care.
USE 4-6 scholarly, peer-reviewed sources, NO INTERNET SOURCES. Use reading list provided below.

Required Readings
Anonymous. (2011, July 15). Utilization review accreditation admission accredits MEDecision’s Alineo. Utilization Management. Retrieved November 2012 from Proquest

Anonymous. (2010, September 28). ITA partners receive URAC health utilization management accreditation. Business Wire. Retrieved November 2012 from Proquest

Anonymous. (2010, October 12). Research and markets: Case management: Identifying, monitoring and managing target populations. Business Wire. Retrieved November 2012 from Proquest

Olaniyan, O, Brown, I. L., & Williams, K. (2011). Concurrent utilization reivew; Getting it right. Physician Executive, 37(3), 50-54. Retrieved November 2012 from Proquest

Saunier, B. (2011). The devil is in the details: Managed care and the unforeseen costs of utilization review as a cost containment mechanism. Issues in Law & Medicine, 27(1), 21-48. Retrieved November 2012 from Proquest

Tubbs, S. L., Husby, B., & Jensen, L. (2011). Ten common misconceptions about continuous improvement efforts in healthcare organizations. The Business Review, Cambridge, 17(2), 21 – 28. Retrieved November 2012 from Proquest

Concurrent Utilization Review: Getting It Right Olakunle Olaniyan, Iskla L Brown, Kayode Williams. Physician Executive. Tampa: May/Jun 2011. Vol. 37, Iss. 3; p. 50 (5 pages). Retrieved November 2012 from Proquest

Optional Readings
Fiscella, K., Volpe, E., Winters, P., Brown, M., & Idris, A. (2010). A novel approach to quality improvement in a safety-net practice: Concurrent peer review visits. Journal of the National Medical Association, 102(12), 1231-1236. Retrieved November 2012 from Proquest

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