Quality Management as a Strategy for Utilization Management: Using Statistical Process Control to Manage the Care of High Risk Patients

OPEN MINDS, The Behavioral Health & Social Service Industry Analyst Industry Analysis Traditionally, managed care organizations (MCOs) have managed inpatient utilization using pre-admission certification and concurrent review. This strategy usually achieves the greatest reduction of hospital days during the first year of implementation and levels off thereafter. However, it might be argued that the concurrent review process prevents length of stay from rising back to pre-managed care levels. The concurrent review model can sometimes be a contentious and hostile process that antagonizes and alienates clinicians. Despite the standard usage of level of care or patient placement criteria, decisions . . .