|  | Healthcare Industry | Health Insurance

Medical Utilization Management Analysis Techniques

Utilization management in the health care industry refers to the medical facility's use of equipment, treatments, staff and other "utilities." The management of the facility's utilities helps determine its effectiveness and efficiency. There are several techniques for conducting an analysis of utilization management, which are part of a larger utilization review.

  1. Sources for Analysis

    • The sources of the data will determine, in part, what types of analysis methods are appropriate and how effective the analysis techniques are. Data can be gathered from preadmission to concurrent care to discharge. At each step, it is important to gather consistent data for each patient. Examples of the types of data to collect are the plan of treatment (admission), appropriateness of treatment (concurrent care) and the discharge plan. For each type of data gathered, it is useful to have a form for the reviewer to fill out to ensure the same data have been collected for each patient.

    Descriptive Statistics

    • Descriptive statistics for analysis include occupancy ratios, mortality rates (if appropriate) and length of stay. Statistical techniques to analyze this numerical data include calculating averages, percentiles, standard deviations and ratios. Descriptive statistics can help illustrate the relationships between different sets of numbers and measure against expected values.

    Control Charts

    • Control charts were invented by Walter Shewhart in the 1920s. They are used as a visual representation of an individual's or group's performance. To create a control chart, first data is gathered from the entire sample. For example, the number of medical coding errors for the entire facility could be gathered. On a graph, a line is made for the average, a line for the lower limit and a line for the upper limit. Then, the target data source (for example, a department within the facility) is scored on the chart. The individual scores will show where they fall between the upper and lower limits, and if they are close to the average. This helps determine if a particular source's scores need improvement or exceed expectations.

    Process Capabililty Analysis

    • A process capability analysis is conduced using multiple control charts. If the multiple control charts for a specific process do not show much individual variation, a process capability analysis can be conducted. By graphing the results of the individual control charts, bottlenecks and delays can be identified by isolating the needs of an individual or a step.

Health Insurance - Related Articles