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Utilization Review

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  • Topic: Utilization review
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Appropriate and Inappropriate Imaging Rates for Prostate Cancer Go Hand in Hand by Region, as if Set by Thermostat

April 1, 2012 | Journal Article

Policy-makers interested in containing health care costs are targeting regional variation in utilization, including the use of advanced imaging.

Most Health Care Organizations Address Patient Safety Only Indirectly

July 1, 2004 | Program Result

From 2002 to 2003, research staff at URAC studied utilization management companies to learn how they use utilization management technology and processes to identify and manage potential patient safety problems.

Utilization Management Can Negatively Impact Health Care Quality and Access

June 1, 1999 | Program Result

From 1992 to 1997, researchers at the University of Washington School of Public Health and Community Medicine evaluated the effects of utilization management on health care quality and access.

How Satisfied are Physicians and Patients When Medical Groups Control Access to Care?

April 1, 1997 | Program Result

The University of California, Los Angeles, School of Medicine examined how the structure and intensity of utilization management in physician groups with capitated contracts affect primary care physician and patient satisfaction.

Florida Develops Utilization Management System for Youth Mental Health Services

June 1, 2000 | Program Result

A 1996 legislative mandate directed Florida's Agency for Health Care Administration to develop a utilization management system for Medicaid-funded mental health and substance abuse services in order to achieve $34 million in savings.

How Will Comparative Effectiveness Research Affect the Quality of Health Care?

February 1, 2010 | Issue Brief

Paper explores the potential impact of comparative effectiveness research and looks at implications for quality of care and health outcomes.

Post Claims Underwriting and Rescission Practices

January 1, 2009 | Report

Study details regulations and enforcement needed to fill gaps in protecting consumers in insurance markets.

Reducing Payment for Imaging in Referring Doctor's Facility Does Not Reduce Utilization

August 1, 1998 | Program Result

From 1994 to 1996, researcher teams at the University of Virginia and the Primary Care Outcomes Research Institute (PCORI) at the New England Medical Center conducted two distinct but parallel studies.

New Studies by RWJF Scholars Focus on Malpractice, Tort Reform, Error Disclosure Laws

September 15, 2010 | Story

Research published in a special issue of "Health Affairs" journal--and featured at a National Press Club event--estimates liability costs at 2.4 percent of overall health care total.

Spillover Effects of Community Uninsurance on Working-Age Adults and Seniors

September 1, 2011 | Report

This article explores the indirect, or spillover, health care effects of a high uninsurance rates. Working-age adults with private insurance living in areas with a high rate of uninsurance were less likely than their peers in areas with a low uninsurance rate to have a usual source of care, an office-based visit, and any medical care expenditures.

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