Utilization Management

For this discussion, you are taking on the role of the director of utilization management at Mount St. Clare Medical Center. Some practice variations have been observed among health care providers at your medical center. Your CEO asks you to conduct training for your health care providers.

In your initial post,

-Differentiate three basic components of utilization management as depicted in Figure 5.1 in Chapter 5 of your textbook.

–Explain the importance of drug utilization review and step therapy.

-Distinguish between disease management (DM) and case management.

-Examine a successful DM program (e.g., Aetna Health Connections disease management program) from real-life provided by an employer, hospital, health insurer, or other entity.

Be sure to address its accreditation or certification status, if any, and its impacts on health care quality and cost.