Utilization Review
Superior Health Outcomes
Quality of Care. Trust our utilization review to track each step of medical care to ensure the selection of the most cost-effective and highest-quality medical care available. Our nursing team monitors treatment progress to make sure that patients receive the most appropriate care for their individual needs. As a result, patients experience superior health outcomes more quickly, hence diminishing the need for costly treatments, hospitalizations, and prescription medications.
The Process
Comprehensive Services.. As a proactive resource for providers, payers, patients and physicians, Primary PhysicianCare's utilization review addresses each case individually, evaluating care options and giving people the information they need to make educated decisions.
Utilization review encompasses the following services:
- A complete analysis of all potentially high-cost services, including but not limited to homecare, skilled nursing facilities, rehabilitation facilities, physical therapy, chiropractic visits, intravenous antibiotic therapy, total parenteral nutrition, chemotherapy and medical equipment
- Exploration of less costly treatment solutions
- Evaluation of medical claims for appropriateness of medical treatments and hospitalizations
- Monitoring of treatment plan adherence to medical guidelines
- Monitoring of medical care and services during hospitalizations, including hospital rounds every two days
- Post-hospital follow-up to ensure treatment plan compliance and appropriate self care
- Comprehensive report outlining services and utilization savings from Primary PhysicianCare’s program
