The following statements are about risk management for case management. Three of the statements are true and one is false. Select the answer choice containing the FALSE statement.
Most health plans require a PCP referral or precertification for CAM benefits.
The Strathmore Health Plan uses clinical pathways to manage its acute care services. In order to reduce the risk of financial liability associated with the use of clinical pathways, Strathmore and its network hospitals should
The Glenway Health Plan's pharmacy and therapeutics (P&T) committee conducted pharmacoeconomic research to measure both the clinical outcomes and costs of two new cholesterol-reducing drugs. Results were presented as a ratio showing the cost required to produce a 1 mcg/l decrease in cholesterol levels. The type of pharmacoeconomic research that Glenway conducted in this situation was most likely
One way that health plans evaluate their UR programs is by monitoring utilization rates. By definition, utilization rates typically
