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Utilization Management The Session Long Project for this course is to evaluate and critique a health care facility you are familiar with and compare it to the general principles and standards for...

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Utilization Management

The Session Long Project for this course is to evaluate and critique a health care facility you are familiar with and compare it to the general principles and standards for quality assurance presented in this course.

In the earlier modules you identified a health care facility for the subject of the SLP and presented a description of the facility and its quality assurance program. You also critiqued the facility's Continuous Quality Improvement program.

In this module you will discuss and critique the subject facility's Utilization Management program. The remaining modules for the Session Long Project the remaining tasks are as follows:


SLP Assignment Expectations

For this module you are to complete the following tasks and to submit a 4- to 5-page paper. (This does not include the title or reference pages):

  • Describe and discuss the facility's Utilization Management program.
  • Compare and critique the subject facility's Utilization Management program to that of a model facility and whether the facility adheres to the recognized standard for utilization management, including utilization review and whether this review leads to improvement in the quality of care.
  • Identify areas for improvement in the facility's Utilization management program, if any, and any recommendations you think should be implemented to improve the quality of patient care.

I need 5 pages, APA, 4-5 in-text citations, 4-5 references

Answered Same Day May 05, 2020

Solution

Soumi answered on May 08 2020
137 Votes
Running Head: UTILIZATION MANAGEMENT    1
UTILIZATION MANAGEMENT         2
UTILIZATION MANAGEMENT
Table of Contents
Introduction    3
Utilization Management Program of Envita Medical Center, USA    3
Comparing Envita Medical Center’s Utilization Management Program to a Standard Facility in terms of Utilization Management and its Role in Improvement to Care Quality    4
Identifying Areas for Improvement    6
Conclusion    7
References    8
Introduction
    Envita Medical Center is a renowned healthcare facility in the US, which has been famous for its inclusion of a vast spectrum of treatment facilities for both advanced and conventional medical issues. Their quality assurance system, as assessed previously, is quite an effective one, which has ensured that every patient receives high quality care and is able to retain their optimal state of well-being. This connects their operations to the way they assess if all the requests for availing healthcare services are valid, under the concept of utilization management. This idea has been analyzed in this assignment critically.
Utilization Management Program of Envita Medical Center, USA
    Envita Medical Center is at the heart of providing diversified health care services to the citizens of US as well as to people all around the world. Hence, their operations are needed to be planned on a larger scale that encompasses the utilization of a vast resource. As mentioned by Adirim, Meade and Mistry (2016), the resources of a health care organization are similar to those of any other type of service organizations, in terms of using physical, financial and human resources.
Hence, it is a matter of fact that Envita Medical Center needs to plan their budget implementation to where they are investing and in what amount. This is important because as viewed by Mathias et al. (2016), resource allocation is one of most serious concerns of an organization in order to locate if their resources are being used in the appropriate functions in the appropriate ways.
Therefore, for Envita Medical Center as well, they evaluate this aspect by reviewing that if a request is generated to them for availing a medical facility by any patient, then that is a valid one or not. Especially, this is more important to them, as they are highly considered for providing cancer treatment facilities, which is an indispensable requisite for the cancer patients (Envita, 2018). Hence, they assure that their resources are wasted or inappropriately allocated to fulfilling any unnecessary medical request that could have been refused, otherwise.
They conduct this procedure by reviewing those requests, under the utilization management program, which includes assessing the medical requests made and analyzing their suitability. As defined by Mospan and Alexander (2017), utilization management is the process of evaluating the necessity and appropriacy of the health care services being provided, the resources being used, the procedures being followed for them as well as the effectiveness of these aspects.
According to this...
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