Utilization management (UM) has become a strong trend in health care cost containment. Under UM, some decisions are not strictly made by the doctor and patient alone. Instead, they are now checked by a reviewer reporting to an employer or other paying party who asks whether or not the proposed type or location of care is medically necessary or appropriate.
This book presents current findings about how UM is faring in practice and how it compares with other cost containment approaches, with recommendations for improving UM program administration and clinical protocols and for conducting further research.
Table of Contents
|Utilization Management: Introduction and Definitions||13-26|
|Origins of Utilization Management||27-57|
|The Utilization Management Industry: Structure and Process||58-90|
|Impact of Prior Review Programs||91-118|
|High-Cost Case Management||119-142|
|Conclusions and Recommendations||143-162|
|Appendix A - Legal Implications of Utilization Review||169-204|
|Appendix B - Utilization Management and Quality Assurance in Health Maintenence Organiztions: An Operational Assesment||205-245|
|Appendix C - Utilization Management in Peer Review Organizations||246-249|
|Appendix D - Summary of Public Hearings||250-252|
|Appendix E - Summaries of Committee Site Visits to Utilization Management Organizations||253-281|
|Appendix F - Analysis of Agreements Between Utilization Management Organizations and Their Clients||282-287|
|Appendix G - Glossary and Acronyms||288-292|
|Appendix H - Biographies of Committee Members||293-300|
The National Academies Press (NAP) has partnered with Copyright Clearance Center's Rightslink service to offer you a variety of options for reusing NAP content. Through Rightslink, you may request permission to reprint NAP content in another publication, course pack, secure website, or other media. Rightslink allows you to instantly obtain permission, pay related fees, and print a license directly from the NAP website. The complete terms and conditions of your reuse license can be found in the license agreement that will be made available to you during the online order process. To request permission through Rightslink you are required to create an account by filling out a simple online form. The following list describes license reuses offered by the National Academies Press (NAP) through Rightslink:
Click here to obtain permission for the above reuses. If you have questions or comments concerning the Rightslink service, please contact:
Rightslink Customer Care
Tel (toll free): 877/622-5543
To request permission to distribute a PDF, please contact our Customer Service Department at 800-624-6242 for pricing.
To request permission to translate a book published by the National Academies Press or its imprint, the Joseph Henry Press, please click here to view more information.