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Related Experiment Videos

Enhancing utilization review program results.

M Martin, A Milstein, D V Loveland

    Health Cost Management
    |February 9, 1988
    PubMed
    Summary

    Utilization review (UR) programs show varied effectiveness in managing healthcare costs. Evaluating UR firm performance requires robust criteria and methods to ensure true contributions are measured.

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    Area of Science:

    • Healthcare Management
    • Health Services Research

    Background:

    • Utilization review (UR) programs are increasingly diverse.
    • Their impact on healthcare cost management varies significantly.
    • Effectiveness assessment of UR programs is crucial for payers.

    Purpose of the Study:

    • To evaluate the effectiveness of private utilization review firms.
    • To discuss criteria and methods for gauging UR program performance.
    • To provide insights for payers' healthcare and cost management efforts.

    Main Methods:

    • Evaluation of over 100 private UR firms.
    • Analysis of state-of-the-art criteria and methods.
    • Expert discussion by senior executives from National Medical Audit.

    Main Results:

    • Significant variation in the contributions of UR programs to cost management.
    • Identification of key factors influencing UR program effectiveness.
    • Need for standardized evaluation approaches.

    Conclusions:

    • The effectiveness of utilization review programs is not uniform.
    • Advanced criteria and methods are necessary for accurate assessment.
    • Payers must carefully select and monitor UR firms for optimal results.

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