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