Health care providers and other
interested parties must continuously look for ways to manage limited resources
while improving quality and promoting patient safety. Utilization management is
intended to “make sure that health care is delivered in the most efficient
and effective manner for the patient and the population, where such activities
directly impact the quality of outcomes” (Pelberg in Varkey, p. 145). The
utilization management process bridges clinical, financial, and administrative
Within traditional health care settings, utilization management
can have a significant impact on the delivery of services. In addition, various
models of care are emerging that may help transform health care delivery to
achieve the aims of utilization management and quality
To prepare for this Application:
Review the information on
utilization management in Chapter 7 of Medical Quality Management. Also
conduct additional research using the Walden library and credible Web sites
(some of which are listed under Optional Resources).
Analyze the Chronic Care Model
and the Patient-Centered Medical Home Model. How might these models be
beneficial for providing care to patients, especially those with multiple
Identify the elements of each
of these models, and evaluate which may be most significant for achieving
quality and safety goals. Consider each of the six dimensions of quality
identified by the Institute of Medicine.
Reflect on how these models
should be structured in order to achieve the best medical outcomes for
individual patients at the lowest cost to society.
Write a 2- to 3-page paper that addresses the following:
Compare and contrast the
Chronic Care Model and the Patient-Centered Medical Home Model.
Evaluate which elements of
these models may be most significant for achieving quality and safety goals.
Explain how these models should
be structured in order to achieve the best medical outcomes for individual
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