Common Utilization Measures That Impact Value-Based Care Efforts

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Quality and quantity have a nuanced relationship in the healthcare system: put simply, payers want to reduce members’ quantity of low-value services while increasing the number of services that produce better quality care. As a result, utilization measures that track the use of high- and low-value care are critical to a value-based structure. The triple aims of value-based…

What is Utilization Management?

Garrett SchmittNo Comments,

UM  is an important, systematic process that promotes efficiency in healthcare.  When performing UM, care managers consider the following factors to determine the appropriateness of care for a member: The severity of symptoms, acuity of symptoms, prior treatment efforts, clinical diagnosis, and level of impairment in functioning. Clinical outcomes research and level of care guidelines….