Managing resources. Directing patients to appropriate specialist care.
Patients and physicians are wary that managed care will unnecessarily limit access to specialists. At the same time, there is a recognized need to control medical costs. Clinical decision support criteria can help group practices achieve balance between clinical protocol and cost management. They help protect against over- and underutilization of resources, including specialist care. They also help physicians justify care decisions to the patient and to the health plan providing payment.
Hongsermeier
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InterQual, Inc., Marlborough, MA 01752, USA.
D003363:Cost Control; D003661:Decision Support Techniques; D019468:Disease Management; D015276:Health Care Rationing; D006297:Health Services Accessibility; D006801:Humans; D008329:Managed Care Programs / Q000592:standards*; D008511:Medicine; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D012017:Referral and Consultation / Q000191:economics / Q000458:organization & administration*; D013038:Specialization; D014481:United States