Ensuring quality care: what do you get for your money?
In the rush to produce balanced scorecards and outcomes measures, managed care organizations must recognize the need to better assess the clinical competencies of their contracted skilled nursing facilities. Health plan quality management staffs, although composed of gifted professionals, generally do not have sufficient skilled nursing facility (SNF)-related experience or knowledge to support evaluation and qualification of these providers. The successfully implemented Altman-Conrad (A-C) SNF quality management process objectively measures and monitors managed care contracted services provided by SNFs. The A-C process requires a health plan's quality management/utilization management staff to engage in a team-based educational endeavor. This effort is designed to generate measurable outcomes specific to the health plan's needs. The proven benefits of the process include improved member services, greater member satisfaction, more productive days for SNFs, more effective discharges, and the generation of a win-win relationship between the health plan and its contract providers.
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D002983:Clinical Competence; D003284:Contract Services / Q000592:standards; D003625:Data Collection; D008329:Managed Care Programs / Q000458:organization & administration*; D015397:Program Evaluation; D019984:Quality Indicators, Health Care; D012866:Skilled Nursing Facilities / Q000191:economics / Q000458:organization & administration / Q000592:standards*; D019467:Subacute Care / Q000592:standards; D017749:Total Quality Management / Q000379:methods* / Q000458:organization & administration; D014481:United States; D014600:Utilization Review