Proper Utilization Management: A Key to Improved Patient Care

young female caregiver helping senior woman getting upAll hospitals, regardless of their size and location, always have patients to look after and take care of. In fact, with the rise in the number of people who now have health insurance, experts forecast these healthcare and medical facilities to become even busier in the following years.

While the increase in the insured population is definitely a good thing, it also poses even more challenges for these institutions – and the people tirelessly working for the sake of its patients. This is where improving utilization management in hospitals comes in.

What the numbers say

Hospitals in the United States receive millions of visits every year, with outpatient visitors alone having reached 125.7 million in 2015. Emergency rooms/departments take the lead when it comes to having the highest number of received patients, at 141.4 million. This makes sense, seeing as the ER/ED serves as the contact point of a hospital’s other departments.

One of the primary challenges that arise from this is how consumers, especially those with insurance, actually behave. It’s understandable that they worry – even panic – when they feel something isn’t right with their health, but in most cases, they make the mistake of heading straight to a hospital (usually the ER or ED) even when their condition doesn’t warrant urgent or emergency care. As a result, this adds to the already numerous tasks of hospital staff.

A solution to the upward trend in the number of hospital patients

Improving utilization management is vital to a fully functional healthcare facility. Utilization management, at its core, consists of several components, all of which contribute to achieving the goal of not just meeting compliance standards when it comes to patient care, but also improving the patient experience.

Determining whether a patient has to remain confined in the hospital, referred to a specialist, or tagged as outpatient are all critical functions of proper utilization. As such, managing this can keep hospital operations smooth and intact while also lessening the burden placed on the healthcare professionals and the hospital staff.