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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 cost to health plans was reported at between $10 and $25 per request by 2013. [2] It was estimated in 2009 that prior authorization practices cost the US healthcare system between $23 and $31 billion annually. [14]
Psychiatric rehabilitation, also known as psychosocial rehabilitation, and sometimes simplified to psych rehab by providers, is the process of restoration of community functioning and well-being of an individual diagnosed in mental health or emotional disorder and who may be considered to have a psychiatric disability.
UPMC's Provider Services consists of an array of clinical capabilities that includes hospitals, specialty service lines (including transplantation, behavioral health, cancer care, children's health, women's health, and rehabilitation services among other centers, institutes, and services), contract services (emergency medicine, pharmacy, and ...
There are also inpatient rehabilitation hospitals that offer this service in a hospital-like setting, but separate from acute care facilities. Most inpatient rehabilitation facilities are located within hospitals. The objective of rehabilitation is to cure a patient completely. However, exact goals vary for each person. For instance, someone ...
Comprehensive rehabilitation is provided by specialists in this field, who act as facilitators, team leaders, and medical experts for rehabilitation. [ citation needed ] In rehabilitation, goal setting is often used by the clinical care team to provide the team and the person undergoing rehabilitation for an acquired disability a direction to ...
Step therapy, also called step protocol or a fail first requirement, is a managed care approach to prescription.It is a type of prior authorization requirement that is intended increase insurance company profits at the expense of patient health by forcing patients onto lower cost prescription drugs.
Drug rehabilitation is the process of medical or psychotherapeutic treatment for dependency on psychoactive substances such as alcohol, prescription drugs, and street drugs such as cannabis, cocaine, heroin, and amphetamines.