Utilization Management Statistics 2024 – Everything You Need to Know

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Are you looking to add Utilization Management to your arsenal of tools? Maybe for your business or personal use only, whatever it is – it’s always a good idea to know more about the most important Utilization Management statistics of 2024.

My team and I scanned the entire web and collected all the most useful Utilization Management stats on this page. You don’t need to check any other resource on the web for any Utilization Management statistics. All are here only 🙂

How much of an impact will Utilization Management have on your day-to-day? or the day-to-day of your business? Should you invest in Utilization Management? We will answer all your Utilization Management related questions here.

Please read the page carefully and don’t miss any word. 🙂

Best Utilization Management Statistics

☰ Use “CTRL+F” to quickly find statistics. There are total 39 Utilization Management Statistics on this page 🙂

Utilization Management Latest Statistics

  • Cumulatively, our program has achieved significant success, saving millions of dollars in blood components and reducing inpatient tests per discharge by 26%. [0]
  • Utilization Management – Key Statistics Average Utilization Management ROI – 6.6 to 1 Percent of Utilization Management cases referred to American Health Case Management – 22.1% Case Management – Key Statistics. [1]
  • *) Individuals who refused Case Management services in 2019 – 2.74% (compared to an industry average of 11.27%*). [1]
  • Overall member satisfaction in 2019 – 96.71% (compared to an industry average of 96.21%*). [1]
  • Average annual claim cost reduction per managed member – $5,364 Percent of Disease Management participants who are satisfied with the program – 99.2%*. [1]
  • PreAdmission Counseling – 61% lower Post Discharge Counseling – 35% lower. [1]
  • Both PreAdmission and Post Discharge Counseling Rate – 47% lower. [1]
  • During the intervention period, there were significant reductions in utilization of all chemistry tests (from 7% to 40%). [2]
  • The estimated reduction in expenditures for “routine” blood tests and chest radiographs was 17%. [2]
  • The denial rate was approximately 2% to 3% overall, but many of the denials were later reversed. [3]
  • The estimated gross cost savings resulting from reduced hospitalization time and decreased outpatient care was approximately $5 million. [3]
  • A survey conducted in 1983 reported that only 14 percent of corporate benefit plans required prior approval of nonemergency admissions to hospitals. [4]
  • Perhaps half to three quarters of employees nationwide are now covered by such programs, up from only 5 percent in 1984. [4]
  • In 1987, the latest year for which statistics are available, total spending on health care reached an estimated $500 billion, up from $234 billion just 5 years earlier. [4]
  • This spending has been increasing at a rate considerably above the rate of general inflation , and the share of the gross national product attributed to health services went from 5.9 percent in 1965 to 11.1 percent in 1987. [4]
  • Spending for health care by business as a percentage of the gross private domestic product grew from 1.1 percent in 1965 to 3.4 percent in 1987. [4]
  • In 1987, spending for health care by business equaled about 6 percent of total labor compensation compared with about 2 percent in 1965. [4]
  • A recent survey of nearly 800 employers of all sizes reported average premium increases from 1987 to 1988 of 11 percent for conventional insurance plans and between 8 and 10 percent for HMOs. [4]
  • Another survey cited average increases from 1987 to 1988 of 14 percent for employers with insured programs and 25 percent for employers with self. [4]
  • This small percentage of individuals—perhaps 1 to 7 percent of a group—may account for 30 to 60 percent of the group’s total costs. [4]
  • For the United States as a whole in 1980, 1 percent of the population accounted for 29 percent of total health care spending. [4]
  • In an earlier review paper, Wickizer traced the growth and evolution of UR through the 1980s and noted that by 1985 a substantial majority (>70%). [5]
  • Physicians responding to the survey reported that 50% to 60% of their patients were subject to some form of UR. [5]
  • , in 1965 only 40% of the population had a regular physician who was a generalist, 15% had a physician who was a specialist, and 45% had no regular physician. [5]
  • That evaluation found that pre admission review reduced admissions significantly (approximately 10%) but concurrent review had only a modest effect (2% to 3% reduction). [5]
  • The combined effect of the two UR activities was to reduce hospital inpatient days per 1000 insured persons, on average, by approximately 12%. [5]
  • The result was a net decrease in total per capita medical expenditures of approximately 5%. [5]
  • Contrary to common belief, pre admission review resulted in few (<2%). [5]
  • Whereas mental health patients, including patients with a diagnosis related to substance abuse, represented only 5% of the study population, they accounted for over 50% of the total days saved due to UR. [5]
  • In contrast, obstetric admissions represented almost 40% of the total number of cases reviewed yet they accounted for a trivial (3%). [5]
  • The fact that obstetric admissions are approved 100% of the time and almost always have short hospital stays, even for cesarean section cases, explains the small proportionate reduction in hospital days. [5]
  • In a fouryear period , lengthof stay authorization decreased by almost 50% for mental health cases and by almost 25% for medical cases. [5]
  • Such patients were 2.7 times as likely to be readmitted within 60 days as patients having no reduction in requested length of stay. [5]
  • Relative to the control group, patients in the case management group had lower rates of readmission during 90day follow up (33% versus 46%). [5]
  • The gatekeeper plan had 6% lower total charges per enrollee compared to the plan without a gatekeeper, primarily due to lower ambulatory care charges associated with reduced use of specialists. [5]
  • found that 48% of primary care physicians reported spending “an inordinate amount of time seeking plan approval for patient’s care.”. [5]
  • Cheadle et al find a significant decline in the number of injuries with loss work time with 15% of injuries in a capitated plan incurring loss work time compared to 19% in the feefor. [5]
  • 405 415mortality associated with CABG fell by >25% almost immediately following feedback of mortality data to hospitals and surgeons; variation in mortality rates across hospitals fell even more dramatically . [5]
  • and his colleagues found less than a two percent reduction in admissions attributed to preadmission review…. [5]

I know you want to use Utilization Management Software, thus we made this list of best Utilization Management Software. We also wrote about how to learn Utilization Management Software and how to install Utilization Management Software. Recently we wrote how to uninstall Utilization Management Software for newbie users. Don’t forgot to check latest Utilization Management statistics of 2024.

Reference

  1. nih – https://pubmed.ncbi.nlm.nih.gov/21173132/.
  2. americanhealthholding – https://www.americanhealthholding.com/OurResults/MetricsOfSuccess.
  3. nih – https://pubmed.ncbi.nlm.nih.gov/12196088/.
  4. nih – https://pubmed.ncbi.nlm.nih.gov/10457504/.
  5. nih – https://www.ncbi.nlm.nih.gov/books/NBK234995/.
  6. annualreviews – https://www.annualreviews.org/doi/10.1146/annurev.publhealth.23.100901.140529.

How Useful is Utilization Management

One of the key benefits of utilization management is its ability to curb unnecessary healthcare costs. By analyzing patterns of utilization and determining the appropriateness of care, healthcare providers can avoid unnecessary tests, procedures, and treatments that may not improve patient outcomes. This not only saves money for both providers and patients but also helps reduce the risk of potential harm from unnecessary interventions.

In addition to cost savings, utilization management also has a significant impact on the overall quality of care delivered to patients. By optimizing the use of healthcare services, providers can ensure that patients receive timely and appropriate care that meets their individual needs. This can help improve patient outcomes, increase patient satisfaction, and ultimately enhance the overall patient experience.

Utilization management also plays a crucial role in promoting evidence-based medicine. By reviewing the latest clinical guidelines and research findings, utilization management programs can help healthcare providers make informed decisions about the most effective and appropriate treatments for their patients. This ensures that patients receive the most up-to-date and clinically proven care, leading to better outcomes and improved quality of life.

Another important aspect of utilization management is its focus on coordinating care across different healthcare settings and providers. By facilitating communication and collaboration between various healthcare professionals, utilization management can help ensure that patients receive seamless and coordinated care that is tailored to their specific needs. This can help prevent gaps in care, reduce redundant or unnecessary services, and improve overall care continuity.

While utilization management has many benefits, it is not without its challenges. One common concern is the potential for utilization management programs to impede access to necessary care or create unnecessary barriers for patients seeking treatment. Healthcare providers must strike a delicate balance between controlling costs and ensuring that patients have access to the care they need in a timely manner.

Overall, utilization management is a valuable tool for optimizing healthcare resources, improving quality of care, and enhancing patient outcomes. By effectively managing the use of healthcare services, providers can benefit from cost savings, improved care coordination, and better patient outcomes. Utilization management is an essential component of modern healthcare delivery and will continue to play a critical role in shaping the future of healthcare.

In Conclusion

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