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Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
The higher amount paid by certain payers might be intended not only to address below-cost reimbursements, but also the volume of payers and the desired total margin, especially of a for-profit hospital or healthcare organization. When fixed costs rise (i.e. administrative expenses) the willingness of medical facilities to cost cut of possible ...
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This cost-spreading mechanism often picks up much of the cost of health care, but individuals must often pay up-front a minimum part of the total cost (a deductible), or a small part of the cost of every procedure (a copayment). Private insurance accounts for 35% of total health spending in the United States, by far the largest share among OECD ...
The generic model used in the United States is the chronic care model, which holds that health care does not only involve change in the patient and that high-quality disease care counts the community, the health system, self-management support, delivery system design, decision support, and clinical information systems as important elements in ...
Program management, on the other hand, evaluates success based on long-term strategic benefits and overall organizational impact. A program encompassing projects to reduce operating costs, for instance, would measure success by the extent to which these cost savings contribute to improved financial performance over time. [2] [6]
Operating room management is the science of how to run an operating room suite. Operational operating room management focuses on maximizing operational efficiency at the facility, i.e. maximizing the number of surgical cases that can be carried out on a given day while minimizing the required resources and related costs.
Revenue cycle management (RCM) is the process used by healthcare systems in the United States and all over the world to track the revenue from patients, from their initial appointment or encounter with the healthcare system to their final payment of balance. It is a normal part of health administration. The revenue cycle can be defined as, "all ...