Jove
Visualize
Contact Us
JoVE
x logofacebook logolinkedin logoyoutube logo
ABOUT JoVE
OverviewLeadershipBlogJoVE Help Center
AUTHORS
Publishing ProcessEditorial BoardScope & PoliciesPeer ReviewFAQSubmit
LIBRARIANS
TestimonialsSubscriptionsAccessResourcesLibrary Advisory BoardFAQ
RESEARCH
JoVE JournalMethods CollectionsJoVE Encyclopedia of ExperimentsArchive
EDUCATION
JoVE CoreJoVE BusinessJoVE Science EducationJoVE Lab ManualFaculty Resource CenterFaculty Site
Terms & Conditions of Use
Privacy Policy
Policies

Related Experiment Videos

Utilization management key to HMO success.

F J Volpe

    Physician Executive
    |April 10, 1987
    PubMed
    Summary
    This summary is machine-generated.

    Utilization management in healthcare ensures patient needs are met efficiently and affordably. This involves cost-effective care strategies and avoiding unnecessary medical procedures and hospitalizations.

    Related Concept Videos

    You might also read

    Related Articles

    Articles linked to this work by shared authors, journal, and citation graph.

    Sort by
    Same author

    The morass of managed care: has it a place for advanced practice nursing?

    Advanced practice nursing quarterly·1995
    Same author

    A conversation on the future of health care.

    Physician executive·1995
    Same author

    A positive experience with a consultant.

    Physician executive·1995
    Same author

    Continuity of care: some experiences and thoughts.

    Physician executive·1994
    Same author

    Success will require a conscience.

    Physician executive·1990
    Same author

    Medicine, management, and me.

    Physician executive·1988

    Area of Science:

    • Healthcare Management
    • Health Economics
    • Prepaid Health Programs

    Background:

    • Utilization management has historical roots in prepaid health programs, notably capitated, prepaid risk models preceding Health Maintenance Organizations (HMOs).
    • It is broadly defined as systems and procedures designed to meet patient medical needs at the lowest cost while maintaining adequate quality of care.

    Purpose of the Study:

    • To define and elaborate on the principles and practices of utilization management within healthcare systems.
    • To highlight the importance of cost-effectiveness and quality assurance in healthcare delivery.

    Main Methods:

    • Review of historical practices in prepaid health programs.
    • Identification and categorization of common utilization management strategies.

    Related Experiment Videos

  • Analysis of cost-containment measures and quality considerations.

    • Main Results:

    • Utilization management encompasses strategies to avoid unnecessary medical interventions such as surgery, hospitalization, and diagnostic tests.
    • Emphasis is placed on promoting cost-effective alternatives like home health care services.
    • Securing services at the lowest cost through strategic contracting is a key component.

    Conclusions:

    • Effective utilization management is crucial for controlling healthcare costs in prepaid systems.
    • Balancing cost reduction with the maintenance of adequate quality is a central challenge.
    • Strategic contracting and the judicious use of services are vital for optimizing healthcare resource allocation.