While utilization management (UM) is often used interchangeably with utilization review, UM’s role oversees the entire spectrum of a facility’s health services, including procedures as well as use of treatment facilities, ensuring that appropriate care is provided without overusing facilities. Utilization tasks include improving clinical efficiency, managing patient appointment, physician time management as well as analyze data for evidence-based best-practice outcomes.
As the healthcare industry moves from fee-for-service to a results-based model, collecting and integrating data and coordinating tasks requires top-level facility process management, as several facilities and practitioners have discovered. Here are some of their tips for improving a facility’s utilization management that worked for them:
Define the program outcomes and interventions with a best practice system
Hospitals have become aware that data-driven decisions, such whether to become an accountable care organization or developing a specialized cardiac care center, require performance improvement tracking to ensure success. Because all of the various components of a healthcare facility’s relationships and interactions both shape and are shaped by the system, it’s critical for any meaningful healthcare performance improvement and metrics to be integrated into the facility’s objectives strategy.
Use software and technologies designed for utilization management
Acquire the best electronic health records (EHR/ EMR) software on the market that is specialty-driven and optimized for ease of sharing and transparency, recommends the staff of Viewics. Top-flight UM technologies have the capability to not only chart and code more accurately to help manage the utilization process but can reduce unnecessary testing and procedures, such as laboratory tests.
Specialized software programs offer newer protocols such as simple search of structured and unstructured data, helping to reduce denied claims.
Unlock data by using analytics to identify areas of opportunity
For optimum performance accountability, a healthcare organization needs a robust analytics program able to fully integrate the full complex of sources (financial, claims, clinical and operational, for example) for making data sharing fast and transparent. Healthcare organizations seeking to analyze and discover data patterns should utilize interactive technology to enable easy parsing of data to find what you need and derive operational insights..
Partner with an experienced practice management service
Working with a third party partner experienced in UM and care management services can provide the successful advocacy and technological expertise necessary for practices and other health organizations, while boosting the bottom line. With an increase in regulations mandating clinically cost-effective solutions, the importance of accurate, transparent data collection, analysis, and distribution with healthcare teams as well as payers has become more important than ever.
Example of how to create utilization management success
Many hospitals currently have a labor-intensive system of data collection, including clinical, scheduling and EHR information, that leaves them unable to maximize fast, sound decision-making. In this case, the entire UM process likely needs to be completely overhauled to enable these hospitals to reach its goals.
When that extends to UM, procedures should be implemented that allow for the harnessing of big data for maximum operational insights.
By integrating data enterprise-wide, hospitals may reach financial goals more quickly, see improvements in physician services, and reduce unnecessary care or hospital stays. The review component helps providers and payers become more efficient throughout the denial review and management process.
When optimized for data-sharing, analysis and utilization management, partnering with third-party management and review services can improve care outcomes while containing costs.