title: Designing a guideline-based utilization management program.
abstract: Many public and private organizations are developing and publishing clinical guidelines to assist health care providers and patients in making appropriate medical decisions. Unless clinical guidelines are part of a well-designed managed care program, they have little effect on physician practice styles. This article explores integral components of an effective guideline-based utilization management program. Initial evaluation of this program suggests that, as part of a well-designed utilization management program, clinical guidelines can inform patients and physicians, and create appropriate incentives for effective health care delivery.
authors: A S
authors: AS
authors: Wilson
authors: I H
authors: IH
authors: Scheibner
authors: C M
authors: CM
authors: Winslow
mesh_terms: D002985:Clinical Protocols; D003363:Cost Control / Q000379:methods; D005568:Forms and Records Control; D007221:Industry / Q000592:standards; D007343:Insurance Carriers; D008329:Managed Care Programs / Q000191:economics / Q000592:standards*; D010934:Planning Techniques; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000592:standards*; D016730:Program Development / Q000379:methods; D012017:Referral and Consultation / Q000592:standards; D014481:United States; D014600:Utilization Review / Q000379:methods*