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Curriculum Category: Effective and Efficient Care
Utilization Management in Health Systems and Managed Care Organizations
 
UPDATED: July, 2005
 

Burns S. How medical managers avoid mindsets that are minefields. Managed Care Magazine. January 2001;10(1). http://www.managedcaremag.com/archives/0101/0101.costly.html

Carneal G. The evolution of utilization management. Managed Care Interface. Dec. 2000;13(12):86-92.

Collins B, Hawks J, Davis R. From theory to practice: identifying authentic opinion leaders to improve care. Managed Care Magazine. July 2000;9(7). http://www.managedcaremag.com/archives/0007/0007.opinionleaders.html

Cross M. More plans discover value of health risk assessments. Managed Care Magazine. October 2004;13(10). http://www.managedcaremag.com/archives/0410/0410.healthriskassess.html

Dalzell M, ed. Too many books: how to tell the best cooks? Managed Care Magazine. April 1998;7(4). http://www.managedcaremag.com/archives/9804/9804.cookbook.shtml

Greenberg L, Carneal G, Hattwick M. Trends and Practices in Medical Management: 2001 Industry Profile. URAC, February 2002. http://www.urac.org/release.asp?releaseid=23

Gross PA, Greefield S, Cretin S, et al. Optimal methods for guideline implementation. Medical Care. 2001;39(8):SII 85-92.

HMO Workgroup for Care Management. One Patient, Many Places: Managing Health Care Transitions, February 2004. http://www.ahip.org/content/default.aspx?bc=38|65|69. Summary: http://www.ahip.org/content/default.aspx?bc=31|130|136|271|276

Kerr EA, Hays RD, Mitchinson A, Lee M, Siu AL. The influence of gatekeeping and utilization review on patient satisfaction. Journal of General Internal Medicine. May 1999;14:287-96.

Lynch JP, Forman SA, Graff S, Gunby MC. High-risk population health management: achieving improved patient outcomes and near-term financial results. American Journal of Managed Care. July 2000;6(7):781-91.

Mason J, Freemantle N, Nazareth I, et al. When is it cost-effective to change the behavior of health professionals? JAMA. Dec. 19, 2001;286(23):2988-2992.

Mays GP, Claxton C, White J. MarketWatch: Managed care rebound? Recent changes in health plans' cost containment strategies. Health Affairs. Web Exclusive, August 11, 2004. http://content.healthaffairs.org/webexclusives/index.dtl?year=2004

Mays GP, Hurley RE, Grossman JM. An empty toolbox? changes in health plans' approaches for managing costs and care. Health Services Research, February 2003;38(1), Part II:374-393. http://www.hschange.org/index.cgi?func=pubs&what=4

Mirvis D, Chang C. Managed care, managing uncertainty. Archives of Internal Medicine. February 24, 1997;157:385-388.

Mottur-Pilson C, Snow V, Bartlett K. Physician explanations for failing to comply with "Best Practices". Effective Clinical Practice. Sept/Oct 2001;4:207-213. http://www.acponline.org/journals/ecp/pastiss/so01.htm

Robinson J, Yegian J. Medical management after managed care. Health Affairs. Web Exclusive, May 19, 2004. http://content.healthaffairs.org/webexclusives/index.dtl?year=2004

Singer S, Bergthold L, et al. Decreasing Variation in Medical Necessity Decision Making. Final Report to the California HealthCare Foundation, August 1999. Center for Health Policy, Stanford University. http://www.chcf.org/ (Located under the topic, Managed Care)

Singer SJ, Bergthold LA. Prospects for improved decision making about medical necessity. Health Affairs. January/February 2001;20(1):200-206.

Sipkoff M. Preauthorization remains prevalent and useful among physician groups. Physician Practice Options. May 15, 2000. http://www.mdoptions.com/

The National Guideline Clearinghouse™. Fact Sheet. AHRQ Publication No. 00-0047, July 2000. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/ngcfact.htm

Weingarten S. Using practice guidelines compendiums to provide better preventive care. Annals of Internal Medicine. March 2, 1999;130(5):454-8.

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