Barber R L
Carolinas Hospital network, Charlotte, NC, USA.
Healthc Financ Manage. 1997 Mar;51(3):41-2, 44.
Managed care plans are driven to meet consumer quality of care demands. But, plans that meet these consumer demands do not necessarily meet provider expectations for quality business partnerships. Therefore, providers need to develop not only clinical performance indicators but also indicators that will help them evaluate managed care plans as business partners. Performance indicators should be developed to measure managed care plans' medical loss ratio, compensation cost/benefit, payment promptness, authorization convenience and promptness, insurance verification convenience and promptness, payment accuracy, medical management, provider relations responsiveness, member education effectiveness, recorded complaints, risk transfer, contract terms, and contract equity.
管理式医疗计划致力于满足消费者对医疗质量的需求。但是,满足这些消费者需求的计划不一定能满足提供者对优质商业伙伴关系的期望。因此,提供者不仅需要制定临床绩效指标,还需要制定有助于他们将管理式医疗计划评估为商业伙伴的指标。应制定绩效指标来衡量管理式医疗计划的医疗损失率、补偿成本/效益、付款及时性、授权便利性和及时性、保险核实便利性和及时性、付款准确性、医疗管理、提供者关系响应性、会员教育效果、记录的投诉、风险转移、合同条款和合同公平性。