Public-private coalition for reducing health care administrative costs through the standardization and electronic exchange of health care data.

Philosophical view or doctrine of ethics that the purpose of all action should be to bring about the greatest happiness for the greatest number of people and that the value of anything is determined by its utility.

Measurement of the frequency that members of a health insurance group use the services or procedures of a particular benefit plan, stated by average number of claims per insured over a specific time period.
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How much a covered group uses a particular insurance plan or program.

Program that replaced the Professional Standards Review Organization (PSRO) program. See Quality Improvement Organization (QIO) program .

Process and procedures implemented to administer the use of health care services in the hospital by evaluating quality of care and establishing appropriateness and medical necessity for services. It ensures maximum medical care resource use and helps reduce health care spending. Examples of UM are preadmission certifications, admission reviews, concurrent reviews, focused reviews, individual case management, discharge planning, retrospective reviews, provider profiling, and second surgical opinions.