Discuss the utilization control methods of gatekeeping and the three types of utilization review in terms...

Discuss the utilization control methods of gatekeeping and the three types of utilization review in terms of how they try to contain costs.

Describe the different types of long-term care services that are available.

Solutions

Expert Solution

Gate keeping is an arrangement that requires a primary care physician to coordinate all services
-Emphasizes preventive care
-Secondary care provided only when referred

Process of evaluating the appropriateness of services provided is called utilization review ,

There are 3 types
1. Prospective
2. Concurrent
3. Retrospective

prospective utilization -medical necessity is determined before care is delivered.

concurrent utilization - decisions are made during the course of health care, most commonly used in discharge planning .

retrospective utilization - utilization after services have already been delivered, patient has already had health care, services have already been provided.

Long Term care - Is variety of services which is made to meet a patients health or personal care needs for a long period of time. These services help people live independently and safely when they cannot perform day to day activities on their own. It can be provided in different places by different caregivers, depending on a person's needs. Most long-term care is provided at home by unpaid family members and friends. It can also be given in a facility such as a nursing home. Home health care is the most regularilized long time service it includes nursing care to help a person recover from surgery, an accident, or illness. Home health care may also include physical, occupational, or speech therapy and temporary home health services. These services are provided at the homes of the patients.

Nightingale answered 1 year ago

Next > < Previous

Related Solutions

Describe and discuss strategy review, evaluation, and control processes, criteria, and methods used.

Perform a web-search and locate information about utilization review in healthcare. What is utilization review? How...

Perform a web-search and locate information about utilization review in healthcare. What is utilization review? How does it relate to Health Information Management? How does it relate to coding? What are skill needed to perform utilization review?250 words

Compare types of authorization systems used to control the utilization and cost of health care services....

Compare types of authorization systems used to control the utilization and cost of health care services. Explain one type of authorization and where it would be used.

Utilization Review and Quality Management Directions As employers look to control health care costs, MCOs have...

Utilization Review and Quality Management Directions As employers look to control health care costs, MCOs have implemented utilization review protocols to ensure the right care is provided to patients at the right time. At the same time, employers, regulatory agencies and accreditation organizations have increased their expectations that the quality of care increases for patients receiving care through the MCO. In no less than 4 and no more than 6 pages, write a paper that addresses the following: • Define...

There are five different types of control methods that managers can utilize to maintain control. These...

There are five different types of control methods that managers can utilize to maintain control. These are bureaucratic, concertive, objective, normative and self-control (self-management). Please compare and contrast the different types of control methods. Please describe which method you think is the most effective and which one is the least effective. Which method would you prefer to use as a manager? Does this differ from which method you would like to work under as an employee?

Discuss various methods for measuring Quality and Utilization by a health plan. Which are most effective,...

Discuss various methods for measuring Quality and Utilization by a health plan. Which are most effective, and why?

Define deviance and explain three methods of social control

Review the methods available for circular slip slope stability analysis in terms of both total and...

Review the methods available for circular slip slope stability analysis in terms of both total and effective stress and explain the circumstances in which each method would be used.

Identify and explain three types of control and the components common to all control systems.

Review the following scenario, and then discuss it in terms of both functional and dysfunctional conflict...

Review the following scenario, and then discuss it in terms of both functional and dysfunctional conflict within an organization. Last year, an organization established a company policy requiring that all employees smile and make eye contact with customers. Since then, employee grievances have continued to escalate. In the last month alone, 10 employees from three different stores have filed grievances. Most of them list customer harassment as a major issue: The customers assume that the employee is flirting with them...

Subjects