PubMed · 891189
The source did not provide an abstract. Follow the original record for more information.
Explore connections, maps & timelines
1977. Utilization review.. https://pubmed.ncbi.nlm.nih.gov/891189/
Cite the original work for its findings. Save a collection to share your selection of sources.
KEEP EXPLORING
Blue Cross and Blue Shield of Massachusetts, Inc (BCBS), has developed two new methods for measuring the effect of utilization management (UM) in reducing unnecessary hospital use. The "program component" method measures the separate effect of preadmission review, concurrent review, and discharge planning. The "savable days" method produces a composite measure of the effectiveness of the program as a whole. The use of these two methods is illustrated with five years of utilization review data from the BCBS nongroup insurance product. The results can be used by operations managers and policymakers to measure the performance of individual UM components and the program as a whole, to establish goals and monitor program performance, to modify the program in response to changing utilization patterns, to assist in developing premiums, to establish risk-sharing agreements with employers or providers, and to demonstrate the effectiveness of the program for use in marketing.
Explore the source record for details and available documents.
Explore the source record for details and available documents.