A fundamental component of the utilization management process occurs after care is given. This process is known as retrospective analysis and its goal is evaluate how effective the services were. During retrospective analysis, patient care data is meticulously analyzed. Some of the factors that are considered are medical necessity, the quality of care, and the appropriateness of the medical setting. This data is then compared with other data sets so that we can identify patterns in the health care services of institutions and physicians and in how our members use health care services.
If you would like to know more about the role that retrospective analysis plays in our utilization management program, please see our Utilization Management Program Description.