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Resource Utilization Groups (RUG) are part of this process, and provide the foundation upon which a resident's individual care plan is formulated. MDS assessment forms are completed for all residents in certified nursing homes, including SNFs, regardless of source of payment for the individual resident.
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 90 HEDIS measures are divided into six "domains of care": [5] [6] Effectiveness of Care; Access/Availability of Care; Experience of Care; Utilization and Relative Resource Use; Health Plan Descriptive Information; Measures Collected Using Electronic Clinical Data Systems; Measures are added, deleted, and revised annually.
Health care managers utilize clinical pathways as a method to reduce variation in care, decrease resource utilization, and improve quality of care. [15] Using clinical pathways to reduce costs and errors improves quality by providing a systematic approach to assessing health care outcomes.
HCUP Logo. The Healthcare Cost and Utilization Project (HCUP, pronounced "H-Cup") is a family of healthcare databases and related software tools and products from the United States that is developed through a Federal-State-Industry partnership and sponsored by the Agency for Healthcare Research and Quality (AHRQ).
The Andersen healthcare utilization model is a conceptual model aimed at demonstrating the factors that lead to the use of health services. According to the model, the usage of health services (including inpatient care, physician visits, dental care etc.) is determined by three dynamics: predisposing factors, enabling factors, and need.
Andrew Witty—who also said that 'the health system needs to function better'— made his comments during an earnings call reporting $14 billion in 2024 net income.
Within the English National Health Service (NHS), a Healthcare Resource Group (HRG) is a grouping consisting of patient events that have been judged to consume a similar level of resource. For example, there are a number of different knee-related procedures that all require similar levels of resource; they may all be assigned to one HRG.