Provider selection standards as a quality indicator.
There are many lessons that PPOs and their clients have learned during the past decade. Data are essential. Few claims administrators have invested the capital or resources to capture other than minimal data--many capturing only the elements required to produce a reimbursement check. The more extensive the data collection, the greater the potential for improving quality. The best way to assure the delivery of high quality health care is to implement a rigorous selection process, preferably prior to granting membership. In an ideal world, selection can lead to the elimination of many aspects of managed care so that the focus can be placed on physicians whose practice style yields lower quality and higher costs. The ability to implement CQI in a PPO is limited only by the ingenuity of the reviewer and the data. Most importantly, the past decade has proven the basic tenet of managed care--quality health care is cost-effective health care.
Zalta
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CAPP CARE, Newport Beach, CA.
D003284:Contract Services / Q000592:standards; D003363:Cost Control / Q000379:methods; D003406:Credentialing / Q000592:standards; D003625:Data Collection; D017723:Drug Utilization Review / Q000706:statistics & numerical data; D017598:Efficiency, Organizational / Q000592:standards; D006761:Hospitals / Q000592:standards; D010560:Personnel Selection / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011243:Preferred Provider Organizations / Q000191:economics / Q000592:standards*; D017749:Total Quality Management / Q000592:standards*; D014481:United States; D014600:Utilization Review / Q000706:statistics & numerical data