What Is Utilization Management in Health Care?


Health care programs have used utilization management activities for more than 20 years, according to Managed Care Resources. Health care providers and patients benefit from UM monitoring systems because they help patients receive the most appropriate care.


Utilization management is the collection, assessment and monitoring of data that pertains to patient services and treatment. UM activities evaluate many aspects of patient care, such as the timeliness of services, the number of bed days used in a hospital, the amount of medication prescribed and a patient’s recovery time.


The health care field relies on utilization management to ensure patients receive appropriate services at the right time, and for the right duration of time. UM activities determine appropriateness of medical services and treatment, so that any unnecessary services can be eliminated. Managed Care Resources says that UM activities even serve to help reduce the number of inpatient stays at hospitals.


Patients benefit from utilization management because it requires continuous review and monitoring of their care. Doctors and health care organizations look for areas of improvement and evaluate statistical trends, such as the average length of stay in a hospital.

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