QUALITY MANAGEMENT

Quality Management are the "buzz words" of the industry. ProMed HCA provides participatory direction to IPA physicians to meet the quality requirements of the industry. ProMed HCA provides resources for the review of charts, procedure documentation, and analysis of utilization data. Our staff has developed graphs, charts and reports which serve as excellent training tools for the practicing physicians and physician leaders. Our systems are established to meet all of the requirements of NCQA, HEDIS, HIPAA, state and Federal Regulators and HMOs. By providing concurrent, prospective, and retrospective data, our physicians, HMOs and employer's needs are satisfied, and our "report card" results are excellent. 

UTILIZATION MANAGEMENT 

Trained case managers provide the physician with daily updates on the status of all hospitalized patients. Case managers are available by phone 24 hours per day, seven days per week. In addition, utilization management reports are provided on a regular basis to the physicians and the IPA's management. We believe that the education of the physician is instrumental to the success of the IPA, on all levels. Each case for specialty medical services is reviewed by our Medical Administration Department. Our standard for authorization response is less than two days and we currently process 98% of our requests within this time frame. The majority of our authorizations are faxed via our dedicated Pentium fax servers, during evening hours. Our full time Medical Director is available for consultation and urgent requests receive an immediate response.

PHYSICIAN TRAINING

The full time Medical Director at ProMed HCA works directly with physicians selected by the IPA as physician leaders. The IPA physician leaders are provided training in managed care operations, quality management and improvement, peer review functions, and assistance in developing referral guidelines. ProMed HCA's Medical Director will share responsibilities with the IPA physician leaders. Ongoing education programs and CME seminars are available. A full network of IPA physician leaders will also share their experiences as one-on-one advisors via telephone or the Internet.

NETWORK DEVELOPMENT & INTEGRATION 

At ProMed HCA, our focus is on building strong, quality networks to meet the needs of the patients, employers, physicians and HMOs. ProMed HCA, Pomona Valley Medical Group, Inc., d.b.a. ProMed Health Network IPA and Upland Medical Group, A Professional Medical Corporation, contract with over 500 physicians, multiple tertiary facilities and ancillary providers. The IPAs and their physicians are able to access all care easily through a participating provider. Our member physicians are able to practice efficient and cost effective medicine within a wide geographic region, and focus on the delivery of medicine, not the negotiation of contracts. Network development is a continually evolving process. We measure the quality of our providers and focus on customer service for all of our clients (physicians, IPAs, patients and HMOs).

IPA MANAGEMENT SERVICES & CAPITATION 

ProMed HCA provides a staff with a proven track record in managing IPAs. Our personnel are well versed in the administration and management of capitation systems. We understand that there are no universal formulas for capitation management, and we are experienced in numerous methods for distribution of capitation revenue. We currently administer multiple payment systems (direct cap, contact cap, point and RBRVS value cap) for our sub-contracted providers. All comprehensive services necessary for the management of an IPA are available through ProMed HCA. These services include, but are not limited to the following:

• Financial Management
• Claims and Capitation Administration
• Information Systems
• Reporting to various agencies & HMOs as required
• Quality Management
• Authorization Administration
• Eligibility and Benefit Interpretation
• Contracting and Credentialing
• Customer Service
• Provider Services
• Planning and Marketing
  

The ProMed HCA executive team provides over 140 collective years of managed care experience. Our approach to management is to customize the systems to meet the needs of the providers. Because of the wide range of experience and knowledge available through ProMed HCA, we are able to accurately assess needs and customize and implement systems to meet the challenges of a new organization, or provide support to an experienced group. We approach each relationship by evaluating the specific needs of the group. This includes evaluation of management, technology, financial, market and operational needs. Strategic planning, development and implementation of systems/operations are a team effort. The participation of IPA representatives, with input and recommendations from ProMed HCA management staff, will provide optimum results. Our clients are also our partners in managed care. The development of an integrated system through ProMed HCA should be considered a step towards future success.