The prioritization of QI activities and clinical studies is necessary in identifying and developing programs that improve care and service. In practice, significant factors that contribute to higher matrix scores are ...
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The prioritization of QI activities and clinical studies is necessary in identifying and developing programs that improve care and service. In practice, significant factors that contribute to higher matrix scores are as follows: The activity affects both high-volume and high-risk populations The activity uses secondary rather than primary data sources The activity incorporates outcome as well as process measures. Through the use of formal, systematic procedures and an objective tool such as the prioritization matrix, quality professionals can develop and successfully implement QI activities and clinical studies. The process described here is useful when resources are limited or fixed or when the activity supports integrated methods used by both MCO clients and other MBHOs, because it can reduce the overall costs of designing a study, implementation, analysis, reporting, and monitoring.
MedSpan, a managed care organization, believes it should provide physicians with maximum input regarding utilization management and practice guidelines. This has been accomplished through nine committees, all of which...
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MedSpan, a managed care organization, believes it should provide physicians with maximum input regarding utilization management and practice guidelines. This has been accomplished through nine committees, all of which report to a Medical Management/Quality Management Committee. This committee structure has allowed MedSpan to avoid the unilateral imposition of guidelines and has enhanced the quality of care and service while decreasing utilization and reducing costs. Examples of specific physician committee actions are included in this article.
Having accurate measures and high-quality health information is critically important for all providers today. Integrated delivery systems are faced with increasing demands for numerous redundant, sometimes conflicting...
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Having accurate measures and high-quality health information is critically important for all providers today. Integrated delivery systems are faced with increasing demands for numerous redundant, sometimes conflicting, performance measurement and reporting data from managed care customers, regulators, and accreditors. When implemented independently within each organizational subunit, these measurement systems are costly and difficult to manage. Centralization of all measurement services can maximize the productivity of the costly resources required to deliver them and can achieve efficiencies, cost savings, and a better balance between internal and external resources while collecting information that is of a higher quality for managerial and clinical decision making.
The Implementation Study of the Fort Bragg Evaluation documented how the Demonstration was executed and whether it met the expectations of the continuum of care philosophy upon which it was based. Based on the theory-...
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The Implementation Study of the Fort Bragg Evaluation documented how the Demonstration was executed and whether it met the expectations of the continuum of care philosophy upon which it was based. Based on the theory-driven and component approaches to program evaluation, a case study methodology was employed. First, the theories and assumptions about the Demonstration were explicated to derive a program model. Next, the program-as-implemented was compared to the program-as-planned. Barriers responsible for diluting full-scale implementation were documented. This study provides a comprehensive description of how the Demonstration was put into place and the evidence necessary to conclude that the Demonstration was executed with high fidelity, despite barriers, to provide an excellent test of the program theory.
Traditional evaluation of health care quality usually involves the measurement of the structure, process, and outcome of care. Most quality improvement programs involve a cycle that includes a setting of goals, a meas...
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Traditional evaluation of health care quality usually involves the measurement of the structure, process, and outcome of care. Most quality improvement programs involve a cycle that includes a setting of goals, a measurement of either process or outcomes, and a real-time or retrospective feedback of the results of data measurement. Benchmarking, a well-known efficient business technology, can lead to practice innovations necessary to survive in an environment that has a need for decreasing cost and increasing quality. The purpose of this article is to present a novel use of benchmarking in managed ambulatory behavioral health care and its application in a model collaborative outcome management project at more than 16 sites and nine states in the United States.
Year 5 of the Massachusetts Behavioral Health Program was a transition to management by a new private managed care organization. Fifty-eight providers interviewed for an ongoing panel survey reported slightly lower le...
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Year 5 of the Massachusetts Behavioral Health Program was a transition to management by a new private managed care organization. Fifty-eight providers interviewed for an ongoing panel survey reported slightly lower levels of quality, access, utilization, and length of stay than a year earlier. Relationships with providers and advocates improved after an initial difficult period, while consumer and family involvement at all levels remained low. The greatest changes in managed care appeared to take place during the initial transition from fee-for-service care, but intractable problems continue, and full participation of stakeholders seems difficult to achieve.
The formation of integrated delivery networks will cause physicians and hospitals to rethink their marketing strategies. As providers align themselves into networks in conjunction with managed care plans, new approach...
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The formation of integrated delivery networks will cause physicians and hospitals to rethink their marketing strategies. As providers align themselves into networks in conjunction with managed care plans, new approaches to marketing will be employed.
Public mental health has long struggled to be accepted as a part of health care. Its interface with social services and its broad spectrum of professionals make a clear definition of public mental health's boundar...
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Public mental health has long struggled to be accepted as a part of health care. Its interface with social services and its broad spectrum of professionals make a clear definition of public mental health's boundaries difficult, fueling policymakers' skepticism about such acceptance. The Oregon Health Plan was the result of a process that explicitly included mental health but recognized that the tools for doing so need to be carefully developed.
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