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v. t. e. Case management is a managed care technique within the health care coverage system of the United States. It involves an integrated system that manages the delivery of comprehensive healthcare services for enrolled patients. [1] Case managers are employed in almost every aspect of health care and these employ different approaches in the ...
Utilization management. Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers, particularly health insurance companies, to manage the cost of health care benefits by assessing its appropriateness before it is provided using evidence-based criteria or guidelines.
A career in healthcare administration consists of organizing, developing, and managing medical and health services. These responsibilities are carried out at hospitals, clinics, managed care companies, public health agencies, and other comparable establishments. This job involves a lot of paperwork and minimal clinical engagement.
Healthcare quality and safety require that the right information be available at the right time to support patient care and health system management decisions. Gaining consensus on essential data content and documentation standards is a necessary prerequisite for high-quality data in the interconnected healthcare system of the future.
Definition. A clinical pathway is a multidisciplinary management tool based on evidence-based practice for a specific group of patients with a predictable clinical course, in which the different tasks (interventions) by the professionals involved in the patient care are defined, optimized and sequenced either by hour (ED), day (acute care) or ...
Health care analytics is the health care analysis activities that can be undertaken as a result of data collected from four areas within healthcare; claims and cost data, pharmaceutical and research and development (R&D) data, clinical data (collected from electronic medical records (EHRs)), and patient behavior and sentiment data (patient behaviors and preferences, (retail purchases e.g. data ...
Andersen healthcare utilization model. The Andersen healthcare utilization model is a conceptual model aimed at demonstrating the factors that lead to the use of health services. According to the model, the usage of health services (including inpatient care, physician visits, dental care etc.) is determined by three dynamics: predisposing ...
Health communication is an area of research that focuses on the scope and implications of meaningful expressions and messages in situations or circumstances associated with health and health care. [ 9 ] Health communication is considered an interdisciplinary field of research, encompassing medical science, public health, and communication studies .