This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Hughes, A. Search for Related Content Social Bookmarking                         What's this?

Potential Conflicts Associated with Utilization Management and Quality Improvement in Home Care

A transition from utilization review to utilization management and quality improvement (UM/QI) is occurring in home health care today. Prior authorization of payment by managed care companies for services delivered by providers is an area of concern. Questions arise regarding service delivery, payment, and patient need. Health care reform calls for agencies to take a closer look at their utilization patterns regardless of the payment source. Services delivered must match patient need for care if the outcomes are to be of high quality and the care cost effective. The UM/QI specialist must be aware of the expectations and requirements of managed care companies, federal and state regulatory agencies, accrediting bodies, and, ultimately, the patients whom they serve. This article discusses the potential conflicts faced by providers and the role of the UM/QI specialist in home health care today.

Key Words: quality improvement • utilization management • utilization review

Home Health Care Management & Practice, Vol. 8, No. 5, 9-16 (1996)
DOI: 10.1177/108482239600800505


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?