Question

please define/demonstrate your understanding of the following terms/topics from Chapter 5.

1.) Utilization Management

2.) Quality Management

3.) Disease Management

4.) Accreditation

Answer 1

1) Utilization Management

Utilization management is the utilization of services within purticular fixed cost. The services should be very essential and benefited to the person. The example is that health insurance companies to manage the cost of health care benefits by assessing its appropriateness before it is provided. The appropriateness of care is evaluated using evidence-based criteria or guidelines.

Utilization management helps to ensure the judicious use of the quality care and resources within the cost. For that there is three types of assessments: prospective, concurrent, and retrospective.

2) Quality Management

Quality management is the overall review of the quality of care.is the act of overseeing all activities and tasks needed to maintain a desired level of excellence. It ensures the quality assurance and improves the quality of health care. It increases the income and productivity of the organization via quality services.

Implementing Quality management tools ensure high customer loyalty and their satisfaction, thus better business, better revenue and better organization will reforms. Through quality management system the fundamental principels of quality upgrades.

3.) Disease Management

Disease management is the mangement or care given to the person having a disease. It consists of different health care interventions. It helps to manage the disease and there by prevents the complications. The goal of disease management is to identify high risk persons for one or more chronic conditions, to promote self-management through communication. It comprised of primary, secondary and teritiary preventive care aspects.

4.) Accreditation

The action or process or certification of officially recognizing someone as having a particular status or being qualified to perform a particular activity.

Accreditation is a third-party certification. It ensure the affiliation of an organization standards as

Educational accreditation is a quality assurance process under which the functions and duties of organizationa are evaluated