Utilization Management (UM) as a process has been gaining importance and prominence in healthcare settings across the globe. In very simple and lucid terms it can be defined as a process for assessing the healthcare services to determine or ensure that the patient care is not only absolutely necessary and imperative but also that it is appropriate, efficient, cost effective, and meets all quality standards. Utilization Management is being used increasingly by people to make sure that they get best treatments at affordable price.
Utilization management describes proactive procedures, discharge planning, concurrent planning, precertification, and clinical case appeals. It also covers processes, such as concurrent clinical reviews and appeals introduced by the provider, payer, or patient (Tricare, 2012). It is about the proper co-ordination and pre-planning of health care. All the processes are well thought of and their implications are taken into account to gauge and check the appropriateness they hold for the patient. All unnecessary procedures are generally chucked out in the starting only. Thus Utilization management primarily concentrates on the welfare of the patients. It not only saves him/her from being exposed to unwanted medical procedures but also accounts for each penny spent. It is a decision making oriented process, which involves proper and appropriate decisions at each step. It pre decides the length of stay of the patient at the hospital to make sure that he/she states for as long as the treatment absolutely requires. Thus Utilization Management takes into account each and every step involved in the health care and provides the patient with the finest option available.
Utilization Management has truly revolutionized the medical world and has increased its accountability and transparency, thus driving the entire process in the favor of patients.
References
Tricare (2012). Utilization Management.
TRICARE Management Activity, Retrieved April 27, 2013, from
http://www.tricare.mil/tma/ocmo/utilizationmanagement.aspx
