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- Title
A Method to Evaluate Utilization Review Program Impact.
- Authors
Levin, Jonathan E.; Ahmad, Khurshid; Ainina, M. Fall
- Abstract
Utilization review (UR) has become a pervasive health care cost containment strategy among U.S. employers. Employers find themselves challenged, however, to quantify the results of UR activity and to evaluate the overall program impact. This article presents a method that permits the UR program impact to be quantified and evaluated within a reasonable amount of time by one person in possession of a few specific facts. The minimum required data elements are listed. A means of adjusting anciliary charges is given in order to develop a potential savings per day of hospital care. There is also some discussion of alternative ways of counting days saved. Because days saved represent the key deliverable of the UR vendor, the vendor's reports may be based on a too liberal means of counting days saved. A means of adjusting clays saved is provided in order to allow one to arrive at a more conservative assessment of program impact. Second surgical opinion programs are discussed, and a similar framework of program impact evaluation is presented.
- Subjects
UTILIZATION review (Medical care); MEDICAL care costs; EMPLOYER-sponsored health insurance; HEALTH insurance; HOSPITAL care
- Publication
Benefits Quarterly, 1989, Vol 5, Issue 3, p32
- ISSN
8756-1263
- Publication type
Article