Utilization management (or utilization review) is a method of controlling health care costs and quality of care by reviewing the appropriateness and necessity of care provided to patients prior to the administration of care (prospective review) or aftercare has been provided (retrospective review).

You are a health care manager in the Performance Improvement Department at your local hospital. You are interested in developing a quality improvement/performance monitoring program.

Instructions

• In a 3-paragraph paper, distinguish the differences between prospective, concurrent, and retrospective utilization management.
• Explain some techniques that are used in each process to evaluate the patient's hospitalization.