Quality Management Services
Quality Management
A continuum of integrated support and process improvement programs and services supporting health care providers, provider systems and health plans with the delivery of high quality medical care.
- Customized service and program solutions for each client
- Improved clinical outcomes through continuous quality improvement in the delivery of medical services
- Demonstrated value through measurable improvements in patient care
Medical Support
Practice management and consulting to support evidence-based improvements in clinical care processes
- Claim audits (medical and pharmacy) with recommendations, educational support and clinical intervention programs and services
- Review and analysis of claims data and practice pattern changes
- Prospective and retrospective drug utilization review with evaluation of provider practice patterns and patient utilization
- Technical support and data auditing services for pay-for-performance provider reimbursement environments
- Services include impact analysis, recommendations, education and implementation of practice improvements
Patient Support
Development and implementation of medical service programs supporting patients in the prevention of illness and the management of chronic conditions
- Outreach programs and services for on-site patient interventions
- Outreach programs and services to support providers in their interactions with patients (e.g. provider offices, clinic systems, hospitals, specialty facilities)
- Providing patient support services (e.g. evaluation of quality of care complaints and grievances) through medical review and mediation
Process Improvement
Analysis and implementation of system and service redesign with a focus on measurable improvements
- Design and development of standardized clinical quality measures to assess the quality of health care services
- Development and testing of interventions designed to assist health care providers in local quality improvement efforts
- Educational programs focused on quality management for health care providers
- Facilitation of cultural change within provider institutions to support process changes and measurable improvements (e.g. onsite/individual support, seminars, conferences, workshops)
- Technical support for the selection and implementation of electronic medical records in various clinical settings
About Quality Improvement Organizations
IFMC holds the Iowa Quality Improvement Organization contract awarded by the Centers for Medicare & Medicaid Services. QIOs work with consumers, physicians, hospitals, and other caregivers to improve care delivery systems to make sure patients get the right care at the right time. Under this contract, IFMC is responsible for:
- Quality improvement tasks for nursing homes, home health agencies, hospitals, and physician offices as well as communications efforts and media relations surrounding these tasks
- Patient and provider education regarding our quality improvement efforts
- Case Review services
- Complaint investigation/mediation
- Data analysis, performance measurement and reporting
About the Iowa Medicaid Enterprise
As a major partner in the Iowa Medicaid Enterprise program, IFMC is helping pioneer new roads for Medicaid. IFMC is one of only a few key vendors working with the State of Iowa Department of Human Services to build an integrated Medicaid Enterprise. The program is designed to transform Iowa Medicaid from a payer of health care claims to a prudent purchaser of health care services. Under this integrated approach, cost efficiencies will be attained not only through management of utilization, claims and revenue, but also through improving quality of care and outcomes. IFMC’s role in the Iowa Medicaid Enterprise includes:
- Long Term Care Assessment
- Medical Prior Authorization
- Early and Periodic Screening, Diagnosis and Treatment
- Targeted Case Management
- Medical Support
- Disease Management
- Enhance Primary Care Case Management
- Preferred Drug List, Drug Utilization Review and Pharmacy Prior Authorization