Comparison of inpatient utilization to optimal standards.
This article summarizes recent analysis concerning variation in the utilization of inpatient hospital benefits by geographic area and for different sources of benefits (health maintenance organization [HMO] versus non-HMO), in comparison to a nationwide standard defined as best observed performance. Observations include significant geographic variations relative to the standard, and the possibility of additional improvements in utilization by managed care organizations. It also notes the importance to benefit plan sponsors of reviewing data concerning the utilization levels of the managed care organizations with which they contract, and references recent comparative results presented for HMOs participating in the New England HEDIS Coalition.
Dymowski
R J
RJ
D000206:Actuarial Analysis; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data; D017598:Efficiency, Organizational; D005431:Florida; D006264:Health Benefit Plans, Employee / Q000592:standards / Q000706:statistics & numerical data; D006279:Health Maintenance Organizations / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data*; D006761:Hospitals / Q000145:classification / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D011787:Quality of Health Care; D014481:United States; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D014600:Utilization Review / Q000706:statistics & numerical data*