In the late 1980s, changes were made to this method of monitoring care and utilization management (UM) was introduced. UM was the evaluation of the appropriateness, medical need, and efficiency of healthcare services, procedures, and facilities according to established criteria or guidelines and under the provisions of an applicable health benefits plan.
If we don’t know where we’ve been, we may not understand where we are now, much less know where we are going. In the late 1970s and early 1980s, the government decided to implement major changes in how hospitals would be paid for providing inpatient care. Healthcare expenses were recognized as being out of control, even back then.
Often times there is a lot of education, support and resources available to a newly diagnosed breast cancer patient. She may meet with a nurse navigator, an NP involves in her surgical management, the surgical oncologist who will be operating on her, the OR scheduler, the appointment scheduling coordinator, and perhaps even other people involved in the first phase of her treatment plan.
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