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The following HTML text is provided to enhance online readability. Many aspects of typography translate only awkwardly to HTML. Please use the page image as the authoritative form to ensure accuracy. Page 302
utilization review efforts/programs, 37, 59, 60-61, 93, 94, 98, 171 CCarotid endarterectomies, 46, 48, 83 Case management, see High-cost case management Ciba-Geigy, 122 Claims administrators prior review by, 61, 68-69, 258-259, 261-262 Claims data defects in cost and utilization data based on, 111, 158 high-cost case identification through, 127 HMO processing of, 220-221 quality-of-care information from, 115 Codman, Ernest, 36 Commercial health insurance companies, see Health insurance industry; Health insurance plans; and individual companies Commission on Professional and Hospital Activities, 81-82 Committee on the Costs of Medical Care, 28 Concurrent review, see Continued-stay/concurrent review Confidentiality of medical information in high-cost case management, 132, 139 n.6 utilization management organization responsibility for, 7 Consumer price index, changes in, 15, 33 Continued-stay/concurrent review appeals processes, 193 by Blue Cross plans, 37 criteria/standards for, 48, 81-82 effectiveness of, 98 focus of, 120 high-cost case management and, 127, 139 liability for, 180 responsibility for, 66 Coronary angiographies, 46 Coronary artery bypass surgeries, 46, 147 Cost management/containment strategies basic elements of, 32-33 benefit plan design, 20, 34-35, 214 control of provider payments, 21, 35 early efforts by third parties, 32-38 effectiveness of, 24-25 employer interest in, 40-43 federal government initiatives, 38-40 financial incentives to providers, 20-21 gatekeeping/triaging, 21 health planning, 35-36 inappropriate utilization as a target for, 44-46 physician education, 21 and quality assurance, 43 and quality of care, 46-47 risk pool management, 33-34 by small businesses, 42 utilization review, 36-38 Costs of health care aging of population and, 24 causes of increases in, 23-24, 32, 115 and clinical judgments about value of treatments, 23 economic shocks and, 40 effects of utilization management on, 1-2, 3-4, 14, 52, 92, 95, 145-146 increases in, 2 information resources on, 47-48 number of providers and, 24, 35-36, 43 prior review and, 92, 100-101, 104 screening for untreatable diseases and, 24 third-party financing and, 28 trends in, 3-4 and U.S. competitiveness, 15 Council on Wage and Price Stability, 40 Criteria for assessment of care adoption and modification of, 83-84, 177-178 appropriateness evaluation protocol (AEP), 80, 82 availability of, 5 competitiveness and, 22-23, 80, 154, 160 computerization of, 80, 107 n.3 diagnosis-specific, 48 differentiation by level of review, 84-85 of HMOs, 215
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