What is the goal of utilization review in case management?

The goal of utilization review in case management is to assess the appropriateness and efficiency of services provided to patients. This process involves examining patient records, treatment plans, and service utilization to ensure that care provided is necessary, effective, and delivered in the most efficient manner possible.

Utilization review helps identify whether the services delivered align with established clinical guidelines and standards. It aims to ensure that patients receive the right level of care at the right time, which ultimately leads to better health outcomes while also managing healthcare costs. By focusing on the appropriateness of services, utilization review can help to reduce the occurrence of unnecessary procedures or extended hospital stays, thereby optimizing resource use in the healthcare system.

In contrast, promoting the use of unnecessary healthcare services would lead to increased costs and potential harm to patients, evaluating patient compliance with treatment focuses more on the patient's adherence rather than the appropriateness of care, and minimizing patient engagement in care decisions runs counter to the principles of patient-centered care, which is vital in effective case management. Thus, assessing the appropriateness and efficiency of services is fundamental to the successful practice of utilization review in case management.