- Using the information in the background readings as well as some research in peer-reviewed sources of your own, which clearly summarizes each of the items below. Include thorough speaker’s notes to further expand upon and explain your points. Use in-text citations on your slides, as well as a reference slide at the end of the presentation.
1. Summarize the three types of assessment to be completed during utilization review. What is involved in each process and who completes this work? What is the health care manager’s specific role in the review?
2. Provide an example of how each of the three types of assessment are performed in the current health care settings. In your three examples, specifically explain how quality was/was not preserved, and how cost was/was not controlled.
3. Describe the role of communication between all stakeholders involved in utilization review. Who are each of the stakeholders, and how should this communication take place? How are decisions best made and communicated, when the review involves competing interests among stakeholders (e.g., for off-label drug uses for terminal patients, handling bed shortages, etc.).
Baker, J. (2018). Improving quality of care through utilization management [Video file]. Retrieved from https://youtu.be/g-T-YeP53nY
Carasso, S. (2017). Is that test necessary? The key to laboratory utilization management.
The Journal of Medical Practice Management: MPM, 33(3), 160-164. Retrieved from the
Trident Online Library.
Desai, S., Gruber, P. F., Eiting, E., Seabury, S. A., Mack, W. J., Voyageur, C., . . . Terp, S. (2017). The effect of utilization review on emergency department operations. Annals of Emergency Medicine, 70(5), 623-631.e1. Retrieved from the Trident Online Library.
El-Othmani, M. M., Sayeed, Z., Ramsey, J. A., Abaab, L., Little, B. E., & Saleh, K. J. (2019).
The joint utilization management program: Implementation of a bundle payment model and
comparison between year 1 and 2 results. The Journal of Arthroplasty, 34(11), 2532-2537.
Retrieved from the Trident Online Library.
Parast, M. M., & Golmohammadi, D. (2019). Quality management in healthcare
organizations: Empirical evidence from the Baldrige data. International Journal of Production
Economics, 216, 133-144. Retrieved from the Trident Online Library.
Suklar, S. (2018). Quality assurance system at primary level of healthcare. Izzivi Prihodnosti, 3(1), 21-53. Retrieved from the Trident Online Library.
Wakefield, E., Keller, H., Mianzo, H., Nagaraj, C. B., Tawde, S., & Ulm, E. (2018). Reduction
of health care costs and improved appropriateness of incoming test orders: The impact of
genetic counselor review in an academic genetic testing laboratory. Journal of Genetic
Counseling, 27(5), 1067-1073. Retrieved from the Trident Online Library.