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Related Experiment Videos

Using quality and efficiency evaluations of physicians.

R D Alexander

    Medical Group Management Journal
    |December 9, 1992
    PubMed
    Summary
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    Quality-focused efficiency (QE) offers a better approach to managed care than traditional utilization review (UR). This strategy uses retrospective analysis to improve cost-effectiveness and reduce administrative burdens.

    Area of Science:

    • Healthcare Management
    • Medical Economics
    • Quality Improvement

    Background:

    • Traditional utilization review (UR) is often process-heavy and invasive.
    • Physicians seek more cost-effective methods for medical care.
    • Managed care needs strategies beyond price discounting.

    Purpose of the Study:

    • To introduce Quality-focused efficiency (QE) as an alternative to traditional UR.
    • To explore the potential of QE in improving managed care outcomes.
    • To highlight QE's benefits for medical group practice managers.

    Main Methods:

    • Replacing case-by-case pretreatment authorizations with retrospective analysis.
    • Analyzing medical practice patterns for quality and efficiency.
    • Implementing a managed care strategy focused on QE.

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    Main Results:

    • QE has the potential to dramatically improve managed care results.
    • QE minimizes irritating aspects of traditional UR.
    • QE offers a way out of price discounting for medical groups.

    Conclusions:

    • QE is a promising strategy for enhancing managed care.
    • Retrospective analysis of practice patterns is key to QE's success.
    • QE empowers medical groups to demonstrate superior quality and efficiency.