Chapter 5: UM, QM, & Accreditation

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Across
  1. 1. _______ is an initiative of the federal AHRQ that seeks to support the assessment of consumers’ experiences with healthcare
  2. 6. _______ health care spans both the management of utilization and quality
  3. 7. A list of drugs covering typical medical needs, although it does not include all available drugs for each medical condition
  4. 10. What types of medications do specialty pharmacies include?
  5. 11. Basic utilization management refers to the routine functions used to manage the cost of the most widely used _______
  6. 12. Self-administered assessment tool used to quickly make an overall assessment of a new patient’s medical condition and risk factors
  7. 13. necessity A factor in coverage determinations when medical goods or services may or may not be covered depending on certain criteria
  8. 14. _______ -based clinical criteria and guidelines are based on formal medical studies and clinical trials that compare different approaches to care
Down
  1. 2. Childhood immunizations are the most common form of _______
  2. 3. _______ utilization management refers to UM activities performed while care is being provided
  3. 4. _______ utilization management refers to UM or UM-related activities that take place after care has been provided
  4. 5. A function of concurrent UM, but it can also be an important element of case management
  5. 6. Payers quality management programs are _______
  6. 8. _______ management is a form of case management that focuses on a handful of selected conditions
  7. 9. Health plan _______ is a forma of oversight in which an independent, private, nonprofit organization reviews an MCO and determines if it meet certain criteria or industry standards