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Utilization management. Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers, particularly health insurance companies, to manage the cost of health care benefits by assessing its appropriateness before it is provided using evidence-based criteria or guidelines.
Preventive health refers to routine care you receive in order to maintain your health. It’s key to diagnosing medical conditions before they become a problem. Preventing serious diseases before ...
CCM is designed to help organize your medications, appointments, and therapies by connecting the dots between your care for different chronic conditions. Under CCM, a healthcare professional will ...
5 min read. Chronic care management (CCM) is a billable Medicare service that’s meant to improve the lives of both patients and physicians. You qualify for CCM services if you have Medicare and ...
Definition. A clinical pathway is a multidisciplinary management tool based on evidence-based practice for a specific group of patients with a predictable clinical course, in which the different tasks (interventions) by the professionals involved in the patient care are defined, optimized and sequenced either by hour (ED), day (acute care) or ...
Health policy can be defined as the "decisions, plans, and actions that are undertaken to achieve specific healthcare goals within a society". According to the World Health Organization, an explicit health policy can achieve several things: it defines a vision for the future; it outlines priorities and the expected roles of different groups; and it builds consensus and informs people.
Medicare managed care plans are often known as Medicare Part C or Medicare Advantage plans. Medicare care managed care plans are an optional coverage choice for people with Medicare. Managed care ...
Medical guideline. A medical guideline (also called a clinical guideline, standard treatment guideline, or clinical practice guideline) is a document with the aim of guiding decisions and criteria regarding diagnosis, management, and treatment in specific areas of healthcare. Such documents have been in use for thousands of years during the ...