Assignment Overview With the consistently rising costs of health care services, utilization management and utilization review are routinely used in the vast majority of current health care settings. How are they evolving over time, and what is involved in these processes? What do health care managers need to be aware of as the processes play out? In the absence of sweeping policy change (or the complete restructuring of the United States health care system), utilization management and utilization review are much more moderate processes to attempt to preserve the quality of care provided while controlling overall health care expenditures. Let’s learn a bit about each of these processes, and how they are implemented in our current health care environment. Case Assignment Using the information in the required readings as well as some additional research in peerreviewed sources, complete your Case Assignment by answering the following: Compare and contrast utilization review and utilization management in health care. What are the similarities and the differences between each type of assessment? (Hint: One is generally a prospective process, and the other is generally a retrospective process). Explain the specific role of each method in providing value-based health care. Who benefits from the method—the health care system, the insurance company, and/or the patient? Articulate how individual case management is critical to a hospital’s long-term survival. In what way does this practice protect your patients while keeping your doors open for business? What are the ethical pitfalls to be aware of in performing these types of quality reviews? What must health care managers be aware of in terms of ethical pitfalls and also potential unintended negative consequences? Assignment Expectations Conduct additional research to gather sufficient information to support your analysis. Provide a response of 3-5 pages, not including title page and references. As we have multiple required items to be addressed herein, please use subheadings to show where you’re responding to each required item and to ensure that none are omitted. Support your paper with peer-reviewed articles and reliable sources. Use at least three references, and a minimum of two of these from peer-reviewed sources. For additional information on how to recognize peer-reviewed journals, see:Angelo State University Library. (n.d.). Library Guides: How to recognize peer-reviewed (refereed) journals. Retrieved from https://www.angelo.edu/services/library/handouts/peerrev.php and for evaluating internet sources:Georgetown University Library. (n.d.). Evaluating internet resources. Retrieved from https://www.library.georgetown.edu/tutorials/research-guides/evaluating-internet-content You may use the following source to assist in your formatting your assignment:Purdue Online Writing Lab. (n.d.). General APA guidelines. Retrieved from https://owl.english.purdue.edu/owl/resource/560/01/. Paraphrase all source information into your own words carefully, and use in-text citations.Module 2 - BackgroundUtilization Management, Utilization Review, and Case Management EssentialsRequired Reading/ViewingView: Baker, J. (2018). Improving quality of care through utilization management [Video file]. Retrieved from https://youtu.be/g-T-YeP53nY Carasso, S. (2017). Is that test necessary? The key to laboratory utilization management.The Journal of Medical Practice Management: MPM, 33(3), 160-164. Retrieved from theTrident Online Library.Desai, S., Gruber, P. F., Eiting, E., Seabury, S. A., Mack, W. J., Voyageur, C., . . . Terp, S. (2017). The effect of utilization review on emergency department operations. Annals of Emergency Medicine, 70(5), 623-631.e1. Retrieved from the Trident Online Library.El-Othmani, M. M., Sayeed, Z., Ramsey, J. A., Abaab, L., Little, B. E., & Saleh, K. J. (2019).The joint utilization management program: Implementation of a bundle payment model and comparison between year 1 and 2 results. The Journal of Arthroplasty, 34(11), 2532-2537.Retrieved from the Trident Online Library.Parast, M. M., & Golmohammadi, D. (2019). Quality management in healthcareorganizations: Empirical evidence from the Baldrige data. International Journal of ProductionEconomics, 216, 133-144. Retrieved from the Trident Online Library.Suklar, S. (2018). Quality assurance system at primary level of healthcare. Izzivi Prihodnosti, 3(1), 21-53. Retrieved from the Trident Online Library.Wakefield, E., Keller, H., Mianzo, H., Nagaraj, C. B., Tawde, S., & Ulm, E. (2018). Reductionof health care costs and improved appropriateness of incoming test orders: The impact ofgenetic counselor review in an academic genetic testing laboratory. Journal of GeneticCounseling, 27(5), 1067-1073. Retrieved from the Trident Online Library.Optional ReadingInstitute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Available at https://www.ncbi.nlm.nih.gov/books/NBK222274/ (Use this link for free full text .pdf download).

Imagine that a group of physicians who are planning to open a single-specialty group practice has hired you as a consultant. Your job is to advise the physicians in creating a business plan that includes management strategies that will help ensure their success. The physicians have stipulated that the plan must promote medical excellence and limit their exposure to risks associated with the practice of medicine and the operational functions of the practice. In addition, they are aware that a public health emergency or natural disaster could have a significant impact on their practice, and therefor they want to include a strategy for emergency preparedness as part of their plan so that they will be able to manage their patients and help serve the community as needed. Compare and contrast the two main levels (i.e., internal comparison and external comparison) of financial benchmarking. Next, analyze the strategic purpose of each level of benchmarking and specify the overall importance of benchmarking as a financial planning tool for a medical practice. Recommend a Health Information Technology (HIT) system that includes an Electronic Health Record (EHR) for the new practice to implement. Support your recommendation by determining three main benefits of having this type of system for the practice. According to the text (p. 368), some of the main areas of risk exposure for a group practice include: property (general liability and safety), technology, and financial practices. Determine one specific hazard associated with one of these risk categories and propose a strategy to mitigate the impact this risk could have on the practice. Support your analysis with a real-life example. Determine the main functions of the practice that will need to remain operational before, during, and after a natural disaster or public health emergency. Next, suggest a strategy that the practice should take to maintain communication with employees and patients, secure patient and financial records, and ensure that resources will available to care for patients during a disaster or emergency. Provide a rationale for your response. Use at least three quality academic resources. Note: Wikipedia does not qualify as an academic resource. This course requires the use of Strayer Writing Standards. For assistance and information, please refer to the Strayer Writing Standards link in the left-hand menu of your course. Check with your professor for any additional instructions.The specific course learning outcome associated with this assignment is: Create a business plan for a physician group practice that promotes medical excellence, limits exposure to risk, and provides a strategy for remaining operational during a disaster or public health emergency.