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discuss the organization and methods of utilization management. This workshop provided initial direction and encouragement for the committee and staff, who held seven meetings between December 1987 and February 1989. In addition to soliciting presentations from knowledgeable persons at committee meetings, the project sought views, data, and ideas through

• 12 site visits to organizations that provide utilization management services (including freestanding firms, insurer subsidiaries, health maintenance organizations, and peer review organizations);

• a June 1988 hearing in which written and oral testimony was presented by over 30 consumer, provider, industry, employer, and other organizations;

• four papers commissioned by the committee from experts in different aspects of utilization management (two of these papers appear in Appendixes A and B of this report); and

• review of published and, in some cases, unpublished literature on the goals, processes, effects, and operating contexts of utilization management.

Additional information was obtained from ongoing discussions with people involved in utilization management as purchasers of utilization management services, suppliers of these services, and subjects of utilization management review, that is, physicians, hospitals, and patients. Reflecting the competitive nature of the utilization management industry, all of the site visits and some other discussions required commitments that the committee would keep confidential any information that would identify the source.

The committee on utilization management plans further work to evaluate the continued course of utilization management and related means of improving the appropriateness and cost-effectiveness of medical services. Other committees and councils of the Institute of Medicine are studying strategies for quality review and assurance, methods for monitoring and improving access for the uninsured, priorities and processes for technology assessment, and problems facing employer-sponsored health benefit plans. This and related work grows out of a continuing commitment by the Institute of Medicine to an agenda of evaluation that encompasses the cost, quality, and availability of health services.


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