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Managing utilization successfully in 12 not-so-easy steps.

T Mayer1

  • 1Managed Care Education Institute for Healthcare Advancement, Whittier, CA, USA.

Healthcare Financial Management : Journal of the Healthcare Financial Management Association
|September 4, 1998
PubMed
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Effective healthcare utilization management requires a coordinated system approach. This involves optimizing care processes, reducing redundancy, and implementing strategies like disease management and patient education for better outcomes.

Area of Science:

  • Healthcare Management
  • Health Services Research
  • Systems Science

Background:

  • Healthcare utilization management is crucial for controlling costs and improving patient outcomes.
  • Traditional healthcare delivery often faces challenges with service coordination and redundancy.
  • A systems approach is needed to integrate various care processes effectively.

Purpose of the Study:

  • To outline a comprehensive system approach for managing healthcare utilization.
  • To identify key strategies for optimizing care delivery processes.
  • To emphasize the role of coordination and alternative methods in healthcare.

Main Methods:

  • Implementing internally developed benchmarks to assess practice patterns.
  • Utilizing hospitalist programs to manage inpatient costs.

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  • Establishing standard protocols and disease state management programs.
  • Coordinating patient access to care through case managers and social service agencies.
  • Promoting patient education and prevention programs.

    • Main Results:

    • Improved efficiency in care delivery by eliminating redundancy.
    • Containment of inpatient costs through hospitalist programs.
    • Maintenance of expected measurable outcomes via standard protocols.
    • Enhanced management of catastrophic care and high-risk populations.
    • Successful integration of patient education and prevention initiatives.

    Conclusions:

    • A coordinated, system-wide approach is essential for effective healthcare utilization management.
    • Integrating various care processes, from benchmarking to patient education, leads to better efficiency and outcomes.
    • Managed care systems can successfully coordinate services to meet diverse patient healthcare needs.