|
Problem:
A selected RPNavigator client wanted to develop a
program for quality profiling that met the regulatory demands of the
state in which it operates. It needed to evaluate its primary physicians in a cost efficient
manner, against Plan standards, peer network performance, and
overall plan performance. Its objective was to identify physician
practices that did not meet Plan standards, to have such practices
take appropriate action to correct deficiencies, to monitor
implementation of corrective actions, and to take action, up to and
including termination, if the corrective action was not implemented.
Solution:
Our Client used RPNavigator’s Practice
Management Index (PMI) Gaps in Care Profile to quickly identify
practices that had quality concerns and to identify for such
practices the specific patients that appeared to not meet national
guidelines and evidence based standards of quality. Physicians
received regular feedback in terms of periodic reports on their
performance compared with their peers and the overall plan. Because the results were based on administrative data,
practices were asked to supply additional information on the
specific members that appeared to not have required screening or
chronic disease monitoring studies. RPNavigator facilitated this process by generating member
lists by practice and by specific gap(s) in care.
Results:
Physicians were impressed with the quality and depth of information on their
members, since it contained clinically germane aspects of quality
about which they were unaware. It enabled them to meaningfully participate in the quality
improvement process since, in some instances, physicians had
important information that the Plan needed to adequately complete
their quality profiling. It also allowed the Plan to meet their
state regulatory requirements and positioned them to improve overall
Plan performance with regard to HEDIS measures. In addition, the Plan now makes the quality profile part of
its re-credentialing process.
|
