What is Utilization Management?
Utilization Management is a set of
guidelines that will help make sure that each person gets the right
services and supports at the right time, in the right amount, and
for as long as they need them.
The Authority’s Utilization
Management plan gives each consumer, and the people closest to them,
the power to make decisions about the best ways to support their
quality of life.
The idea of Utilization Management is
to constantly measure how well the services and supports we are
providing are working so that we can support people in their
personal journeys.
What Utilization Management is not
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A reason to limit services
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A way to limit access to
individual budgets
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A recipe- there is no set model
for services
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A way for people to fall through
the cracks
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A complicated process to
understand
-
A way to make decisions without
consumers
-
A way to reduce access to
services, due process or recipient rights
-
A way to restrict individualized
service and supports
Utilization Management Starts with Person
Centered Planning
A
Person-Centered Plan is a plan about you and for you. It is like a
road map to get you to the life you want. You have the right to
include any friends, family or other people who are important to you
in your planning. Person Centered Planning focuses on what you need
and want in all areas of your life, like:
-
Daily activities
-
Social or family relationships
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Money matters, work or school
-
Legal, safety or health matters
-
Other things that are important
to you or for you
Person Centered Planning is not a
one-time event. You will be given chances to make choices and
say how you feel about the services and supports you are receiving
and the progress you are making toward reaching your goals.
Utilization Management will help make
sure that everyone is getting the right supports and services that
will help them reach their goals, and will help us serve more people
and to serve them better.
How Does Utilization Management Work?
Each
Person Centered Plan will decide on a set of strategies to help to
meet the goals in the PCP. These strategies can include natural and
community supports along with services from the public mental health
system. These services must be authorized, so that we can track what
each person is getting and how it is working for them. The
utilization management process will look at each person’s progress
toward goals. This will tell us if the services are working in the
way they were supposed to.
What will change from the way things are done
now?
The only
real difference that you should notice is that your case manager or
support coordinator will be able to decide with you in your planning
meeting what services and supports you will receive. You should not
have to wait for a plan to be approved. There will still be some
kinds or amounts of service that need to be approved by someone.
But, once your plan is completed you will know what services you
will receive in what amount and for how long. It will also be much
easier for people to see how decisions are made. Our goal is to make
decisions fairer for everyone.
How does Utilization Management Affect You?
What Are the Benefits?
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Focus is on services
-
Consumers and families will
understand how decisions are made
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Everyone will receive equal
treatment in accessing mental health services
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Services will be available when
you need them
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Flexibility in your services
-
Quicker authorization for mental
health services
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Fewer barriers
-
Informed decision making
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Solve problems faster
-
Agency performances are monitored
by the Authority to make sure that all people served by the
community mental health system can achieve their goals
-
Services and supports are based
on needs and goals of the consumer
