Toward effective hospital utilization management. Ten lessons from case studies.

The challenges presented by managed care arrangements and third-party utilization controls have led hospitals to strengthen internal utilization management programs. This article reports findings from a set of case studies on how hospitals have adapted their utilization management programs to their environments. While knowledge acquired from case studies should not be overgeneralized, the findings of these studies suggest some lessons that merit consideration by hospitals advancing their own programs in utilization management.