The University of Michigan Health System is one of the largest health care facilities in the world. The facility is also referred to as the University of Michigan Hospital. It is one of the largest hospitals in the state of Michigan, as well as a premier academic medical center. Michigan Health System has a vision of creating the future of health care through discovery, as well as to become the national leader in care, education, biomedical innovation, and health care reform (Regents, 2015). An important aspect of quality assurance is utilization management. In health care, utilization management that is based on collection, assessment, and monitoring data that pertains to patient services and treatment assures efficiency and effectiveness
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According to the article, “Utilization Management: A European Perspective” (2014), utilization management has been described as an organization wide, interdisciplinary approach to balancing quality, risk, and cost concerns in the provision of patient care. The purpose of utilization management is to identify, monitor, evaluate, and resolve issues that could result in inefficient delivery of care; or impact on resources, services, and patient outcomes (Plebani, Zaninotto, & Faggian, 2014). The main goal of utilization management is to maintain the quality, and efficiency of health care delivery by caring for patients at the appropriate level, coordinating health care benefits, ensuring cost-effective treatment benefit and the provision of medical needs (Plebani, Zaninotto, & Faggian, 2014). The article (2014) also states that due to the increasingly dominant environment of cost containment, utilization management is vital for achieving a balance between efficiency, and quality. The utilization management program for the University of Michigan Health System, or U of M hospital will be discussed. The utilization management program will also be compared to a model facility’s utilization management …show more content…
The hospital (2012) states that there are two questions that should be answered for appropriateness; is the patient sick enough to require care in an acute care setting, and are the services provided ones that can only be provided in a hospital. In order to make these determinations, reviewers from the utilization management team use guidelines and criteria, but also must use clinical judgment since no set of guidelines can address all patient care situations (Regents, 2012). In addition, the utilization management team must also provide payers with clinical updates, and work with the payer to obtain authorization for payment (Regents, 2012). The utilization management program (2012) states that doing so provides assurance to the hospital that they will be reimbursed for the care provided to patients. The Michigan hospital Utilization Management is performed to ensure an effective and efficient medical, and behavioral health care delivery system (Regents, 2012). It is designed to evaluate the cost, and quality of medical services provided. The utilization management program is conducted under the direction of the medical directors, or physicians, and includes both clinical and
According to the article, “Utilization Management: A European Perspective” (2014), utilization management has been described as an organization wide, interdisciplinary approach to balancing quality, risk, and cost concerns in the provision of patient care. The purpose of utilization management is to identify, monitor, evaluate, and resolve issues that could result in inefficient delivery of care; or impact on resources, services, and patient outcomes (Plebani, Zaninotto, & Faggian, 2014). The main goal of utilization management is to maintain the quality, and efficiency of health care delivery by caring for patients at the appropriate level, coordinating health care benefits, ensuring cost-effective treatment benefit and the provision of medical needs (Plebani, Zaninotto, & Faggian, 2014). The article (2014) also states that due to the increasingly dominant environment of cost containment, utilization management is vital for achieving a balance between efficiency, and quality. The utilization management program for the University of Michigan Health System, or U of M hospital will be discussed. The utilization management program will also be compared to a model facility’s utilization management …show more content…
The hospital (2012) states that there are two questions that should be answered for appropriateness; is the patient sick enough to require care in an acute care setting, and are the services provided ones that can only be provided in a hospital. In order to make these determinations, reviewers from the utilization management team use guidelines and criteria, but also must use clinical judgment since no set of guidelines can address all patient care situations (Regents, 2012). In addition, the utilization management team must also provide payers with clinical updates, and work with the payer to obtain authorization for payment (Regents, 2012). The utilization management program (2012) states that doing so provides assurance to the hospital that they will be reimbursed for the care provided to patients. The Michigan hospital Utilization Management is performed to ensure an effective and efficient medical, and behavioral health care delivery system (Regents, 2012). It is designed to evaluate the cost, and quality of medical services provided. The utilization management program is conducted under the direction of the medical directors, or physicians, and includes both clinical and