Ensuring quality care: what do you get for your money?

Area of Science:

• Healthcare Management
• Quality Improvement in Healthcare
• Clinical Competency Assessment

Background:

• Managed care organizations (MCOs) face challenges in evaluating the clinical competence of contracted skilled nursing facilities (SNFs).
• Existing quality management staff often lack specialized SNF experience, hindering effective provider assessment.
• The need for objective measures to qualify SNF providers is critical for MCOs.

Purpose of the Study:

• To introduce and evaluate the Altman-Conrad (A-C) SNF quality management process.
• To provide a framework for MCOs to objectively measure and monitor SNF services.
• To enhance the evaluation and qualification of contracted SNF providers.

Main Methods:

• Implementation of the Altman-Conrad (A-C) SNF quality management process.
• Team-based educational initiatives for health plan quality management and utilization management staff.
• Objective measurement and monitoring of managed care services provided by SNFs.

Main Results:

• Successful implementation of the A-C process.
• Generation of measurable outcomes tailored to health plan requirements.
• Demonstrated improvements in member services and satisfaction.
• Increased SNF productivity and more effective patient discharges.

Conclusions:

• The A-C SNF quality management process offers an objective method for MCOs to assess provider competence.
• This process fosters a mutually beneficial relationship between health plans and their contracted SNFs.
• Implementing the A-C process leads to enhanced quality of care and operational efficiencies.