Do you think utilization management is beneficial for pharmacies and payers (e.g. customer, insurance, Medicare/Medicaid)? Do...

Do you think utilization management is beneficial for pharmacies and payers (e.g. customer, insurance, Medicare/Medicaid)? Do you think utilization management will affect Pay-for-performance (P4P)? Why?

Expert Solution

ANSWER:

UTILIZATION MANAGEMENT:

Utilization management is the evaluation of the medical necessity, and efficiency use of health care services, procedures and facilities.
Utilization management is the process of monitoring the delivery of health care services.
Utilization management involves managing the use of medical services.
With the use of medical services patient receives necessary,proper and good quality care in a cost-effective manner.

Yes, utiliszation management is benefical for pharmacies and payers the benefits are explained below:

PAYERS:

Utilization management is very benefical for payers.
Utilization management reduces all adminstration costs of payers.
Utilization management helps in improving members, and provide better experiences for greater customer retention.
Utilization management achieve a comprehensive view of individual members and patients from all utilization management programs by elimiating datas silos.

PHARMACIES:

Utilization management is also beneficial for the pharmacies.
Utilization management enhance consistency and quality of care of pharmacies by providing medically treatment to patient.
Utilization management provides better care coordination through care pathways,treatment protocols for patients.
Utilization management provide benefirs to pharmacies by saving their tangible cost.

Pay-for-performance:

Pay-for-performance is also known as ''value-based purchasing''.
Pay-for-performance is a model that offers financial incentives to hospitals, medical groups,and other healthcare providers.
Pay-for-performance hepls hospitals,medical centres for meeting certain performance measures.
Pay-for-performance provides financial rewards or penalties to health care providers accroding to their performance.

Yes, utilization management will affect pay-for-performance and the reasons are given below:

Utilization management will definately affect pay-for-performance beacuse they use pay-for-performance frequently.
Pay-for-performance has been widely aqdopted by the utilization management as an incentive to improve health care quality.
Utilization management provides sufficient motivation to improve quality of pay-for-performance.
so, on the basis of above we can say that utilization management will affect pay-for-performance.

NOTE:

In the above, meaning of utilization management.
Benefits of utilization management for payers and pharmacies.
Meaning of pay-for-performance.
Why utilization management affect pay-for-performance is explained above in detail.

keosha answered 6 months ago

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