MetraComp will issue provider 'report cards'; Physician profiling aims at improving care in workers' compensation cases.
Designed by participating providers in the MetraComp Network and network management, the Provider Performance Profile (PPP) will analyze performance parameters and profile its network providers. MetraComp plans to complete the PPP system by mid-1996, using comprehensive data on workers' compensation treatment experience.
"Monitoring provider activities will enable us to apply the principles of continuous quality improvement to our networks," said Steven Rosen, M.D., medical director for MetraComp and the project's leader. "By identifying sub-optimal performance, we can customize and target our educational programs to help improve future outcomes. It is also important to note that physicians were instrumental in creating this system, and it will evolve into a sophisticated peer review process in the near future."
The goal of the PPP program is to gauge the ability of physicians to provide access to efficient and effective medical care, the outcomes resulting from that care and the provider's adherence to MetraComp's Return-to-Work System. The Return-to-Work system is a coordinated treatment effort involving the patient, employer, providers, insurance adjusters and MetraComp's managed care staff, dedicated to providing appropriate care to aid in recovery.
To create the profiling system, MetraComp is building a comprehensive workers' compensation experience database. This will include diagnoses and procedures, disability duration and medical charges, cost comparisons by providers and procedures, and geographic and demographic factors. The database also will target other outcomes data, such as return-to-work dates, availability of modified positions, lost-time cases versus medical only, average cost per claim, litigation rates and other essential information.
While many employee benefits networks have had provider report cards for a few years, it is a relatively new concept in workers' compensation.
"In the future, profiling workers' compensation network providers will be as common as the networks themselves," said Lawrence Dorman, president of MetraComp. "Many states are beginning to require peer review/profiling as part of the managed care certification process. With the PPP, MetraComp will be several steps ahead of the legislative requirements, and, even more importantly, we will be able to respond to market demand for `real results,' such as reduced loss ratios."
With the performance experience data, MetraComp also will be able to offer its services under risk arrangement contracts, Dorman said. MetraComp's long-term goal is to overlay its workers' compensation experience database with experience data from customer group health and non-occupational disability claims to provide outcomes analysis of medical pay out, whether a patient is hurt on, or off, the job.
The MetraHealth Companies, Inc.-- formed Jan. 3, 1995 through the combination of the group medical businesses of Metropolitan Life Insurance Company and the Travelers Insurance Company-- finances, manages and administers health insurance plans and delivers managed care services for its customers. The company serves millions of Americans with health care plans and operates in all 50 states.
CONTACT: Metra Health
Dennis C. Milewski, 203/277-3476
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|Date:||Sep 7, 1995|
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