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Provider profiling: advancing to episodes of care
1Health Payment Review, Boston, MA, USA.
Physician Executive
|September 5, 1995
Summary
Provider profiling, a method to assess healthcare provider practice patterns, is gaining traction. It offers a promising approach to cost-effective care, improving upon older utilization management methods.
Area of Science:
- Healthcare Management
- Health Services Research
- Clinical Practice Evaluation
Background:
- Managed care organizations show significant interest in provider profiling.
- Provider profiling is increasingly adopted or planned by healthcare organizations.
- Professional medical organizations and leading journals cautiously support provider profiling.
Purpose of the Study:
- To highlight the emergence and potential of provider profiling.
- To present provider profiling as a superior alternative to traditional utilization management.
- To emphasize the role of profiling in promoting cost-effective healthcare.
Main Methods:
- Utilizing surveys to gauge adoption rates of provider profiling.
- Referencing position papers from major medical organizations (e.g., American College of Physicians).
- Citing publications in prominent medical journals (e.g., New England Journal of Medicine).
Main Results:
- Provider profiling is recognized as a significant development in healthcare management.
- There is a clear trend towards adopting provider profiling for assessing practice patterns.
- Provider profiling is viewed favorably compared to methods like preauthorization.
Conclusions:
- Provider profiling offers a promising strategy for enhancing cost-effective care.
- It provides a valuable tool for providers to review and modify practice patterns.
- The combination of episode of care methodology and practice benchmarks enables effective clinical profiling.