Concurrent review

Definition

Concurrent review is a process in healthcare management that involves the evaluation of a patient's ongoing care while they are still receiving treatment. This type of review is crucial for ensuring that the care being provided is necessary, effective, and aligned with the patient's health goals. It not only helps in managing costs but also ensures that the quality of care remains high by regularly assessing the appropriateness of treatments as they occur.

5 Must Know Facts For Your Next Test

1. Concurrent review is typically conducted by healthcare professionals who assess patient progress against clinical guidelines and treatment plans.
2. This type of review often involves communication between providers, insurers, and patients to ensure that everyone is on the same page regarding treatment effectiveness.
3. Concurrent reviews can lead to adjustments in treatment plans if a patient is not responding well, preventing unnecessary interventions or extended hospital stays.
4. The process helps manage healthcare costs by identifying and addressing potential over-utilization of services early in the treatment process.
5. Regulatory bodies often require concurrent reviews to ensure compliance with standards of care and patient safety.

Review Questions

• How does concurrent review contribute to improving patient outcomes during their treatment?
  • Concurrent review enhances patient outcomes by enabling healthcare providers to continuously assess the effectiveness of treatments while they are being administered. By identifying any issues early on, adjustments can be made to the care plan if a patient is not responding as expected. This proactive approach helps prevent complications, reduces unnecessary procedures, and ultimately leads to better health results for patients.
• What role do communication and collaboration play in the effectiveness of concurrent reviews in managed care?
  • Communication and collaboration are vital for effective concurrent reviews, as they ensure all stakeholders—providers, insurers, and patients—are informed about the patient's progress and treatment goals. Regular updates facilitate a unified approach to care, allowing for timely interventions when needed. This teamwork helps optimize treatment plans, ensuring they are aligned with best practices and addressing individual patient needs.
• Evaluate the impact of concurrent review on healthcare costs and service utilization in a managed care system.
  • Concurrent review significantly impacts healthcare costs and service utilization by providing ongoing assessments that help identify unnecessary procedures or prolonged hospital stays. By intervening early when treatments are not effective, concurrent reviews reduce over-utilization of services, leading to cost savings for both patients and insurers. Furthermore, this approach encourages efficient resource use within the healthcare system, promoting a more sustainable model that prioritizes quality care while managing expenditures.

Related terms

utilization review: A systematic evaluation of the necessity, appropriateness, and efficiency of healthcare services and procedures used by patients.

care coordination: A collaborative approach in healthcare that ensures patient care is organized and streamlined across multiple providers and services.

quality assurance: A set of activities designed to ensure that healthcare services meet established standards and improve patient outcomes.