What is the primary goal of utilization management in healthcare?

The primary goal of utilization management in healthcare is to ensure efficient provision of healthcare services. This involves reviewing and assessing the appropriateness of the services provided to patients, making sure that the care being delivered is necessary, effective, and in line with established clinical guidelines. By optimizing the services rendered, utilization management aims to balance quality patient care with cost effectiveness, leading to better health outcomes while managing resources efficiently.

In contrast, minimizing patient visits or expanding services significantly shifts the focus of care, rather than optimizing the processes in place. While cutting unnecessary healthcare costs is a component of utilization management, it is a means to an end rather than the primary goal itself; the main focus is on the overall efficiency and appropriateness of healthcare services rather than merely reducing costs.