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Utilization Management, Case Management, and Disease Management: How Do They Interrelate?


There is much confusion about the differences between Utilization Review/Management, Case Management, and Disease Management.  The confusion exists among health care practitioners, payers, and consumers.  This session will discuss the definitions, practice differences and similarities between utilization review/management, case management, and disease management according to URAC's Organization Standards for health care institutional Accreditation, with an emphasis on the practice processes and outcome goals for each.  The evolution of the practices will be discussed as well as the impact of managed care on the evolution, thus providing the attendee with a view to the future.  The demands of the age of consumerism will be presented with a focus on how consumers impact today's practitioners and will continue to do so well into the 21st Century. 

This session will be of interest to practitioners of UM, CM and DM, as well as to health care professionals seeking information on future career opportunities.  Professionals who are responsible for oversight and revision of organizational/departmental Policies and Procedures will gain important information for quality improvement initiatives.  Employers and/or representatives of payors for health care services in all settings will gain an understanding of the differences and similarities between UM, CM and DM in order to appropriately contract for specific services.


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