Utilisation Management: Explained In 5 Steps

1. Utilisation Management (UM) supports access to care, quality of care and the most efficient use of resources to achieve the ultimate aim: service users achieving the highest level of recovery.

2. Utilisation Management is based on 2 principles: the first is that less restrictive settings are intrinsically better for service users (because recovery happens in the community) and the second is that it is important to properly allocate limited resources (because we have a finite amount of money to support care in the NHS).

3. Utilisation Management is delivered through planned individual clinical case consultation and review between provider clinicians and Simplify Health UM clinicians.

4. Levels of Care Criteria are used to determine whether there is reasonable likelihood that service users’ clinical needs can be met at a particular level of care.

5. The data gathered from Utilisation Management Reviews help to inform the system flow and predict where resources are required in a system of care.