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Utilization management. Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers, particularly health insurance companies, to manage the cost of health care benefits by assessing its appropriateness before it is provided using evidence-based criteria or guidelines.
Strategic planning is an organization 's process of defining its strategy or direction, and making decisions on allocating its resources to attain strategic goals. Furthermore, it may also extend to control mechanisms for guiding the implementation of the strategy. Strategic planning became prominent in corporations during the 1960s and remains ...
Cost sharing. Costs are shared when more than one party pays towards the total costs, or accounted for separately across a number of activities or projects . In health care, cost sharing occurs when patients pay for a portion of health care costs not covered by health insurance. [1] [2] The "out-of-pocket" payment varies among healthcare plans ...
Universal health care. Universal health care (also called universal health coverage, universal coverage, or universal care) is a health care system in which all residents of a particular country or region are assured access to health care. It is generally organized around providing either all residents or only those who cannot afford on their ...
The wraparound process is an intensive, individualized care management process for youths with serious or complex needs. Wraparound was initially developed in the 1980s as a means for maintaining youth with the most serious emotional and behavioral problems in their home and community. During the wraparound process, a team of individuals who ...
Informally, a Cadillac plan is any unusually expensive health insurance plan, usually arising in discussions of medical-cost control measures in the United States. The term derives from the Cadillac automobile, which has represented American luxury goods since its introduction in 1902, and as a health care metaphor dates to the 1970s.
Short-term health insurance. In the United States, short-term health insurance ( STHI) or short-term, limited-duration insurance ( STLDI) [1] refers to health insurance plans with a limited duration, typically several months to a year. [2] These plans were initially geared toward people who need temporary medical insurance to bridge the gap ...
Long-term care. Elderly man at a nursing home in Norway. Long-term care ( LTC) is a variety of services which help meet both the medical and non-medical needs of people with a chronic illness or disability who cannot care for themselves for long periods. Long-term care is focused on individualized and coordinated services that promote ...