Semin Med Pract
Basic principles and practices of utilization management
Utilization management (UM) has been portrayed as a drive toward cost containment at the expense of quality. The guiding principles of UM, however, are to minimize inappropriate variations in practice and promote cost-effective patient care, which should meet best practice standards and simultaneously reduce costs. The author provides a brief history of UM in the United States and offers an introduction to several of the more common UM techniques, such as utilization review, physician profiling, case management, and peer review. The author describes some of the criticisms of UM and makes predictions about UM in the future.
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Updated 9/01/09 nvf