A computerized MIS to support the administration of quality patient care in HMOs organized as IPAs.

Abstract

All federally qualified HMOs must develop and implement quality assurance programs for monitoring the quality of care, the quality of services, and the costs of inpatient and ambulatory care. Such quality assurance programs are diverse and vary in administrative structure, criteria, review procedures, feedback, and decision making. This paper describes a computerized quality assurance reporting system operating in an HMO organized as an IPA network. The design and use of various MIS reports containing information on inpatient utilization and costs, physician office visits and physician practice patterns, physician productivity, physician referral patterns and costs, and the health problems of members are presented. The importance of these MIS-generated reports on the operations of IPA medical groups and the HMO and how they are used by medical directors, HMO management, and committees charged with quality assurance responsibilities is also included.