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Utilization Review

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  • Topic: Utilization review
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Access to Care Impacts Hospitalization Rates for Ambulatory Care Sensitive Conditions

April 1, 2001 | Program Result Report

The University of California studied access to primary care in selected communities to assess whether hospitalization rates for certain chronic conditions typically managed by outpatient care are valid and useful measures of community access to care.

Analytical Models Project the Utilization and Costs of Long-Term Care

July 1, 1998 | Program Result Report

The Long-Term Care Data Institute reviewed analytical models then in use for projecting the utilization and costs of different long-term care scenarios, and then used the information gleaned from its analysis to rework its own model.

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.

Denial is Preferred Mental Health Therapy in N.Y.'s Chinatown Since September 11th Terrorist Attacks

May 1, 2004 | Program Result Report

In 2002–03, the Asian American Federation of New York, a non-profit leadership organization, conducted a mental health needs assessment of Asian American World Trade Center victims' families as well as vulnerable populations in New York City's Chinatown district — namely, children, elders and dislocated workers — to document the mental health status, needs and actual service use following the September 11th...

Examining How Intimate Partner Violence is Addressed by Employer Assistance Programs

June 27, 2011 | Program Result Report

Researchers at Johns Hopkins University Bloomberg School of Public Health examined the practices and services related to intimate partner violence offered by employee assistance programs and the experiences of women using these services.

Florida Develops Utilization Management System for Youth Mental Health Services

June 1, 2000 | Program Result Report

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.

Health Expenditures for Privately Insured Adults Enrolled in Managed Care Gatekeeping vs Indemnity Plans

February 1, 2005 | Journal Article

Gatekeeping arrangements, whereby health maintenance organizations mandate that primary care providers approve referrals to specialists, were the focus of the current investigation. Data from the 1996 Medical Expenditure Panel Survey (MEPS) of the A ...

How Do Doctors Decide What Care is Necessary for Mental Health Problems?

November 1, 1996 | Program Result Report

Harvard Pilgrim Health Care documented the implicit criteria used to determine "medical necessity" related to mental health, and the influences of financial incentives and organizational arrangements on medical necessity decisions.

How Managed Care Allocates Resources

March 1, 1998 | Program Result Report

The Hastings Center, a nonprofit bioethics research institute located in Garrison, N.Y., used applied research to examine the ethical questions involved with resource allocation by managed care organizations.

How Managed Care Can Set Limits on Medical Technology - and Look Good

September 1, 2000 | Program Result Report

From 1996 to 1998, Harvard Pilgrim Health Care examined how insurers, employers and other purchasers of health care decide which medical technologies to provide to consumers under resource constraints.

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