Utilization Management and Models of Care Health care providers and other interested parties must continuously look for ways to manage limited resources while improving quality and promoting patient safety. Utilization management is intended to "make sure that health care is delivered in the most efficient and effective manner for the patient and the population, where such activities directly impact the quality of outcomes" (Pelberg in Varkey, p. 145). The utilization management process bridges clinical, financial, and administrative functions. Within traditional health care settings, utilization management can have a significant impact on the delivery of services. In addition, various models of care are emerging that may help transform
health care delivery to achieve the aims of utilization management and quality improvement.
To prepare for this Application:
• Review the information on utilization management in Chapter 7 of Medical Quality Management. Also conduct additional research using the Walden library and credible Web sites (some of which are listed under Optional Resources).
• Analyze the Chronic Care Model and the Patient-Centered Medical Home Model. How might these models be beneficial for providing care to patients, especially those
with multiple medical conditions?
• Identify the elements of each of these models, and evaluate which may be most significant for achieving quality and safety goals. Consider each of the six dimensions of quality identified by the Institute of Medicine.
•Reflect on how these models should be structured in order to achieve the best medical outcomes for individual patients at the lowest cost to society. The Assignment Write a 2- to 3-page paper that addresses the following:
• Compare and contrast the Chronic Care Model and the Patient-Centered Medical Home Model.
• Evaluate which elements of these models may be most significant for achieving quality and safety goals.
• Explain how these models should be structured in order to achieve the best medical outcomes
for individual patients at the lowest cost to society. This Application is due by Tuesday, 16th of October 2014 Your written assignments must follow APA guidelines. Be sure to support your work with specific citations from this week’s Learning Resources and
from additional scholarly sources as appropriate. Refer to the Essential Guide to APA Style for Walden Students to ensure that your in-text citations and reference list are correct. Resources:
• Article: McKeon, L., Cunningham, P., & Oswaks, J. (2009). Improving
patient safety: Patient-focused, high-reliability team training. Journal of Nursing Care Quality, 24(1), 76–82. Retrieved from http://ovidsp.ovid.com.ezp.waldenulibrary.org/ovidweb.cgi?T=JS&NEWS=N&PAGE=fulltext&AN=00001786-200901000-00013&LSLINK=80&D=ovft
Insights from high-reliability organizations are applied to clinical care delivery. • Article: Nadzam, D. (2009). Nurses’ role in communication and patient safety. Journal of Nursing Care Quality, 24(3), 184–188. Retrieved from http://ovidsp.ovid.com.ezp.waldenulibrary.org/ovidweb.cgi?T=JS&NEWS=N&PAGE=fulltext&AN=00001786-200907000-00003&LSLINK=80&D=ovft
This article examines the impact of communication and teamwork on patient safety. • Web Article: Institute for Healthcare Improvement. (n.d.). Chronic care model. Retrieved from http://www.ihi.org/knowledge/Pages/Changes/ChangestoImproveChronicCare.aspx This
resource identifies elements of a model that promotes high-quality chronic care management. • Web Article: The Commonwealth Fund. (2009). Can patient-centered medical homes transform health care delivery? Retrieved from http://www.commonwealthfund.org/From-the-President/2009/Can-Patient-Centered-Medical-Homes-Transform-Health-Care-Delivery.aspx
This article discusses the attributes of the patient-centered medical home model of care.