What is the purpose of utilization management (UM)?

The purpose of utilization management (UM) primarily revolves around controlling the costs of healthcare services while ensuring that patients receive appropriate care. UM involves analyzing and evaluating the necessity, appropriateness, and efficiency of healthcare services, procedures, and facilities to ensure that medical care is delivered effectively and without unnecessary expenditures.

By implementing criteria and guidelines, UM aims to prevent overuse of healthcare resources, which can help keep healthcare spending in check. This ultimately supports the broader goal of maintaining access to necessary services while managing costs for both healthcare providers and insurance companies. Through careful monitoring and strategic planning, UM can facilitate better decision-making regarding patient care, thus bridging the gap between quality care and cost-effectiveness.