The former utilization management
information system was replaced with an integrated product early this year.
In spite of well-established utilization management
programs in for-profit and not-for-profit HMOs, premiums continued to rise and contributed further to health care costs.
The issue of legal liability related to utilization management
activities was first raised in the California case of Wickline v.
Promotional statements may give the impression that utilization management
reviewers are biased and/or have hidden agendas.
Two future activities are required at the Wetaskiwin Hospital to complete the utilization management
For payer organizations, the core systems should include systems that support individual and organizational enrollment; management of provider networks, utilization management
, and claims processing/adjudication/ payment; and investment portfolio management.
Another generic problem within academic centers is ensuring good utilization management
and avoiding delays in care, such as in scheduling of tests, consultations, and procedures as well as in transfer or discharge planning.