Difference Between Utilization Management And Case Management

782 WordsMar 8, 20164 Pages
In order to, differentiate between utilization management and case management using the seven case management standards, it is first important to define each individual component. To begin with, a key component of quality and cost effective care is Utilization Management (UM). Utilization management is a way to assure that the appropriate care is medically efficient, a suitable use of health care services, proper procedures, and is applicable with provisions aligned in the health benefits plan. Case Management engages quality services in a timely coordination of patients’ specific needs in an approach that promotes positive outcomes by means that are cost effective. Case management may be developed during a single health care setting that may then transition throughout the care continuum. The seven standards are key components that described to maximize benefits and minimize the opposition. Capability strategy is the first of the seven standard. In Case management capability strategy leadership accountability is an objective of health care organizations. This leadership role has a greater role in clinical outcomes as the under this standard as case management is intended to improve the management function of clinical care. Capability strategy changes the business climate to continue improvements that “align with the patients’ needs as well as the clinical and operational innovations,” (Wanless, 2010, p. 9). The second standard is the repeatable design, relates
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