Which term describes the system of managing patient care to ensure the necessity of services within HMO plans?

Utilization management is the term that encompasses the strategies used to evaluate the necessity, appropriateness, and efficiency of healthcare services in order to promote optimal patient outcomes while controlling costs. This system is particularly relevant in Health Maintenance Organization (HMO) plans, where it is crucial to ensure that services provided to patients are both necessary and aligned with the overall health plan offerings.

In HMO settings, utilization management involves a variety of processes, including pre-authorization, concurrent review, and discharge planning, which serve to oversee the use of healthcare resources. By managing these aspects, providers can help ensure that interventions are supported by evidence-based guidelines and are delivered in a timely and appropriate manner.

While care coordination focuses on organizing and managing patient care among multiple providers to ensure continuity and efficiency, and primary care management refers to the oversight of a patient's overall healthcare by a primary care provider, it is the utilization management that specifically targets the evaluation of service necessity within the structured framework of HMO plans. The referral system, while important for directing patients to specialists or other services, does not encapsulate the broader objectives of necessity and management of care.