#utilization management

[assurecare]

Utilization Management in the Era of Value-Based Care: Opportunities and Challenges

As healthcare shifts towards a value-based care model, utilization management has become an essential tool for healthcare organizations. Utilization management system refers to the process of evaluating the medical necessity, appropriateness, and efficiency of healthcare services and treatments. 

In the era of value-based care, Utilization management is becoming increasingly important as healthcare shifts towards a payment model that rewards value over volume. In recent years, the healthcare industry has seen a shift from a fee-for-service model to a value-based care model. In this new paradigm, the focus is on delivering high-quality care to patients while minimizing costs and improving outcomes. One important aspect of this new model is the healthcare utilization management solution, which involves monitoring and managing the use of healthcare resources to ensure that they are being used effectively and efficiently. 

One of the main opportunities for hospital utilization management software in the era of value-based care is the potential for cost savings. By carefully monitoring the use of healthcare resources, providers can identify areas where costs can be reduced without sacrificing the quality of care.   Additionally, utilization management solutions can help prevent unnecessary hospital admissions and re-admissions, which can be a major driver of healthcare costs. Another opportunity for utilization management is the potential for improved patient outcomes. By ensuring that patients receive the right care at the right time, Utilization management in healthcare can help prevent complications and improve overall health outcomes. 

Why is Utilization Management Important in Value-Based Care?

Value-based care is becoming increasingly important as healthcare shifts towards a payment model that rewards value over volume. It can help achieve these goals by ensuring patients receive the most appropriate and effective care based on their clinical condition.

Opportunities of Utilization Management in Value-Based Care

Improving Patient Outcomes: Utilization management enables healthcare organizations to ensure that patients receive the most appropriate and effective care based on their clinical condition. This can lead to better health outcomes, reduced complications, and shorter hospital stays.

Reducing Costs: By ensuring that patients receive only the necessary and appropriate care, utilization management can help reduce unnecessary medical expenses, which is especially important in the era of value-based care. This can also help reduce the financial burden on patients and healthcare organizations.

Enhancing Care Coordination: Utilization management can improve communication and coordination between healthcare providers, which can lead to better quality of care and patient satisfaction.

Supporting Evidence-Based Practice: Utilization management is based on evidence-based practice, which means that it is grounded in the latest research and guidelines. By using evidence-based guidelines, utilization management can help ensure that patients receive the most effective and appropriate care.

Challenges of Utilization Management in Value-Based Care

Balancing Cost and Quality: One of the biggest challenges of utilization management is balancing cost and quality. While reducing unnecessary costs is important, it is also essential to ensure that patients receive high-quality care that is appropriate for their clinical condition.

Managing Provider Resistance: Utilization management can be viewed as a threat to provider autonomy, and some providers may resist the implementation of utilization management programs. It is important to address provider concerns and communicate the benefits of utilization management to ensure provider buy-in.

Ensuring Compliance: Utilization management programs must comply with regulatory requirements and guidelines, which can be complex and time-consuming. Ensuring compliance can be a challenge, especially for smaller healthcare organizations.

Data Management: Utilization management relies heavily on data, and managing and analyzing data can be a challenge. Healthcare organizations must have the appropriate infrastructure and expertise to manage and analyze data effectively.

Conclusion

Utilization management is a crucial tool in the era of value-based care. By ensuring that patients receive the most appropriate and effective care. Utilization management also supports evidence-based practice and helps achieve the goals of value-based care. 

Several challenges must be addressed, including conflicts between utilization management and patient care, and the need for accurate and timely data. By addressing these challenges and working collaboratively, providers can leverage utilization management to deliver high-quality care that is both cost-effective and patient-centred.

However, it also poses challenges, such as balancing cost and quality, managing provider resistance, ensuring compliance, and data management. Healthcare organizations must address these challenges to implement successful utilization management programs that improve patient care and reduce costs.

The Future of Utilization management in Value-Based Care is promising, with trends such as artificial intelligence, real-time data analytics, patient-generated health data, and integrated care. Utilization management is a crucial tool in the era of value-based care, providing significant opportunities for improving patient outcomes, reducing costs, and optimizing resource utilization. Healthcare organizations must implement effective Utilization management programs to ensure that they provide high-quality care while reducing costs. Artificial intelligence and machine learning will be used to analyze large volumes of data, real-time data analytics will monitor patient outcomes, patient-generated health data will improve care coordination, and integrated care will involve health care providers, patients, and other stakeholders in the decision-making process.

[ren-144p]

something about the first few episodes of the terror having so many numbers. the men, the provisions, the inventory; but also the tension of counting. the scene where goodsir takes a picture of john franklin and his men and he's counting down the seconds. the lashes being counted down during hickey's punishment. and something about how in later episodes, numbers get lost. dates get forgotten. counting just stops. all of it becomes insignificant. like it was a countdown at first but now the time is just running out instead

[clockworkvampyre]

i noticed that mr enoch drebber has never officially had a completed fullbody reference, so i took matters into my own hands and completed him myself just for fun. it felt like dusting off and repairing an old rusty pocketwatch lmao

i added his original reference for both comparison and convenience. (he is rather tall) (and there is a bonus under the cut)

[sinful-karateka]

I'll bite and talk about something that doesn't get enough spotlight in general, which are Demetri's and Eli's family life. So obviously several fic authors have their own twists and flavors to this, but if I may sell you something for a sec.

So far into the series, what we've got are these facts:

Demetri's Mom is the only family member to be mentioned in the show.

Eli's parents were mentioned a couple of times.

That should be enough context to deduce two things:

Demetri could be an only child to a single mother, and;

Eli's parents involve themselves in the stuff that he does — including karate, who knows — though they tend to be tone deaf with his actual needs.

There's strong evidence to why the boys act the way they act (brain functions notwithstanding, but this isn't the post for that), which is why I think these deductions make sense. How their hypothetical upbringing is part and parcel to how characters behave in this series. Of course societal influence comes in second because obviously you've got a show that encourages learning karate as defense against bullies, but this show is also about generational chains and traumas! So why wouldn't their home life inform the way it informs the LaRusso's, Lawrence's, and Nichols'? But I digress.

In the span of the entire series, I've held onto this headcanon that Demetri's neuroticism and ability to anticipate his actions carefully stem from a household that needs these systems in place, much more for someone who likes to be on top of things. Since he's just a student, the only authoritative figure who can make executive decisions... is his mom. Add to the fact that she may be a working mom, so when Demetri tells Daniel about certain restrictions in learning karate, what could have made her decide to just write a letter instead vs. taking the time out to go with his son herself? I know I know it's narrative writing but like do you seeeee where I'm at here

Eli's family life is by far gave us early indications of his dynamic with his mother — but not so a father — in earlier seasons. It's possible that his mom is a stay-at-home one, but if I were to push the bounds of this box even further, I'd even speculate that she's retired early if it meant that Eli's dad is the one making most of the living. Like of course they'd get mad at Hawk for getting a tattoo at his age, I think any parent would! But the way he tells Aisha to exclude him from her stories tells us that there's not a lot that his parents know about the life he lives as Hawk. At this point we all know the kind of effort it takes to successfully carry it out because he has to go home every night. It's either he a) puts in a lot of effort into concealing this identity once he gets home, or b) his parents are rarely ever home, which again, feeds into another assumption that maybe Mrs. Moskowitz works certain hours.

All we know is they're never around a whole lot for these boys, which is sad! and also again, very Indicative of their classification as awkward nerds pre- and early karate. When I read along certain fics that consider and include how the rest of their characters besides the found families they've formed, it gives much more depth and potency to writing them, their flaws, and how they think.

For all we know, Mrs. Alexopoulos could be a lesbian making fun of her son for not slinging pussy like she does being rizzless unlike her, but don't let me explain that when we have @demetriandelibinaryboyfriends!

[hydrasaura]

Super robot monkey team hyperforce go! ~background/scenery appreciation post ~

[robo-dino-puppy]

horizon forbidden west | the isle of spires 9/?

[mostlysignssomeportents]

Like “realism,” utilitarianism is often code for “being a selfish jerk.” Think of “longtermism,” which concerns itself with a hypothetical future containing trillions of synthetic, simulated humans living inside computers. Making each of those synthetic people very slightly happier will produce a gigantic aggregate benefit.

Even a very small amount of additional happiness multiplied by trillions of imaginary people adds up to more happiness than all of the people currently alive can ever experience. By that reasoning, there’s no amount of misery one could inflict on today’s living people that would outweigh even the chance of bringing a dollop of joy to those far-future sims.

For the selfish, utilitarianism works best when it provides a justification for making themselves better off at others’ expense. At first blush, longtermism militates for everyone to don hairshirts in support of the happiness of those trillions of future sims.

But longtermism is an offshoot of “effective altruism” (whose leading spokescriminal and financier was Sam Bankman-Fried), which offers an ingenious solution to this problem: earning to give.

“Earning to give” is the utilitarian, effective altruist notion that one should take the highest-paying job one can get, even if that job involves inflicting untold misery through pollution, inequality and exploitation — provided that you eventually give all the gains away to good causes that outweigh the harm you did while earning them.

And since succeeding as (say) a high-powered investment banker requires that you wear the finest clothes, drive a showy car, live in a fancy home, fly first class and eat at Michelin-starred restaurants, all of these comforts can be explained as utilitarian necessities one must endure on the path to earning enough to give away so much that you make lots of people better off.

- Rich People's Gain is Worth Less than Poor People's Pain: A new way to think about utilitarianism, courtesy of the Office of Management and Budget

[stunt-lads]

I need someone to pay me money for existing

[windwardstar]

I fucking hate how landlords can just fucking raise your rend endlessly. And that it's oh we need to raise it to keep pace with the cost of living. Like fucker you're the cost of living. You're a big company just trying to drain people of all the money you can. You don't care if the people living in your apartment can afford it only that you get money.

[sunshowersanddandelionwine]

i sent an email to a leasing agent about a possible apartment heres hoping for good news

[benechillax]

man i think i’m 5 seconds away from a mental breakdown

[gothtransandroid]

Contemplating: Necromancy and the Utility of the Skeleton

From aesthetics alone the skeleton does many things for the necromancer. A clear benefit is simply in the knowledge of the subject being a dead thing in and of itself. With any variation of the corpse from zombie to revenant there can be doubts at a glance as to what one is dealing with but moving bones are distinct at most distances and let a person know that any harm they deal to it, accidental or otherwise, wont hurt a living thing. On the other side, the person seeing the skeleton will know that it won't feel pain and has no nervous system holding it back in how strong it will strike someone else. This functions as a form of deterrence from combat as well as telegraphs the danger of handling the skeleton beyond its designated task.

The skeleton, contrary to common sense, is less cost effective than a zombie in terms of raising. The mechanism of imprinting magic upon a corpse via its soulless form means that with less material there, there is more work and more raw magical structure needed to maintain the skeleton. This being said, the zombie will decay and are a short term solution sonits better to invest as a skeleton will be cost effective over time and has the added benefit of not smelling awful. Many an old necromancer cut their noses off and burned their sinuses not just to resemble a corpse in their horde as camouflage, but more so to kill the smell of working with so many zombies.

At an average weight of 20 pounds, the human skeleton is very portable if a single servant is needed and one is conserving their magic between uses. This does covert an unit of 100 servants to about a ton, which could staff a mansion easily and handle all tasks besides handling guests and the cooking for obvious reasons. Like with other skeletons, a human skeleton can utilize their ribs as a means of storage or carrying tools to keep their hands free. Special tools could easily be made for a gardener or a maid to reach in and tend to their tasks while having free hands and look presentable if a chest cover is used to tastefully hide dirty or worn tools.

Besides issues of durability which can be addressed with coatings and reinforcements to the structure of the skeleton, bones tend to still be sturdy even when dry and set, only they cannot self-repair so any damage will need prevented or filled as it occurs. Skeletons are not an unlimited resource, as are bodies in general, but those gathered and maintained properly in a closed and respectful environment can last a lifetime.

[sainteda]

“we have two versions of wesper now! enjoy them both :)” we did not need two and no i won’t

[passengerpigeons]

in a fascinating era where I think people need to realize more that copyright/intellectual property is ultimately an imperfect solution. masters tools and such. like sure it provides protection for artists in an imperfect system but first and foremost it exists to protect the Capital of Capitalists and your argument shouldn't rely on it as an Absolute Ethical Truth. Walt Disney isn't going to fuck you. Some people really see AI and start dick riding copyright law instead of formulating a position based on ethics and power.

[actual-corpse]

My professor was demonstrating Adobe's Project Neo and unenthusiastically showed us the AI integration. (He was working in a 3D rendering program AND streaming Discord on a fucking MacBook)

And he lost the ability to use his keyboard.

And I said, "That's what happens when you use AI"

And he said, "yeaahhh... probably"

[mostlysignssomeportents]

As Quiggin explains, this method would produce some pretty startling policy recommendations:

If a policy halved Elon Musk’s income, while doubling the income of a single randomly chosen US household, it would be evaluated as neutral. If the policy doubled the income of two households, it would be beneficial.

- Rich People's Gain is Worth Less than Poor People's Pain: A new way to think about utilitarianism, courtesy of the Office of Management and Budget