Best practices for managing patient service expectations in a reproductive endocrinology (REI) and in vitro fertilization (IVF) program within a health maintenance organization (HMO) setting

Abstract

OBJECTIVE: Those familiar with HMOs know there are complexities in managing health care services within the managed care (MC) setting. To succeed in improving service within a fee-for-service (FFS) In Vitro Fertilization (IVF) program and a not-for-profit (NFP) Reproductive Endocrinology (REI) practice within a MC setting necessitates a remarkable degree of rigor in order to accomplish the merging of technology and medicine with exceptional quality outcomes. The objective of this abstract is to discuss best practices for managing a shared NFP REI practice and a FFS IVF program within the Kaiser Permanente (KP) HMO setting.DESIGN: Retrospective evaluation based on first-hand knowledge of clinic outcomes and management of a NFP REI practice and a FFS IVF program from January 2007 through May 2008.MATERIALS AND METHODS: Our goal in merging a NFP REI practice and a FFS IVF program was to provide a fuller spectrum of fertility services and continuity of care. Access: Focus on appointment (appt) demand, net loss and demand calculations allow for better appt utilization, access to services and decreased financial net loss. Quality: Quality standards from the IVF lab were established in parallel with the clinic side to maintain consistent quality practices. Staffing: Decentralization of IVF Case Management staff allows for a more consistent level of nursing care at local facilities, improved patient access, better service and physician satisfaction. Charting/Technology: Successful implementation of an electronic medical records program allows clinic to communicate patient information and improved standards of practice for REI and IVF throughout KP. Departmental re-structuring: New positions were developed to allow for a division of work, as well as better utilization of staff. Patient Satisfaction/Service: A variety of patient satisfaction surveys, service contests and team meetings for REI and IVF are used as quality care markers for ensuring consistent patient satisfaction and improved clinic efficiencies.RESULTS: With continued focus, our ability to deliver best practices for REI and IVF is evident by our clinical success rates, quality outcomes, viability of our program, in addition to KP's commitment to expanding both our REI and IVF services within KP.CONCLUSIONS: The nation's leading HMO, KP, has been able to continue to successfully integrate a viable FFS IVF program and NFP REI practice within the MC setting while maintaining the same level of quality, service and accessible personalized care for both. OBJECTIVE: Those familiar with HMOs know there are complexities in managing health care services within the managed care (MC) setting. To succeed in improving service within a fee-for-service (FFS) In Vitro Fertilization (IVF) program and a not-for-profit (NFP) Reproductive Endocrinology (REI) practice within a MC setting necessitates a remarkable degree of rigor in order to accomplish the merging of technology and medicine with exceptional quality outcomes. The objective of this abstract is to discuss best practices for managing a shared NFP REI practice and a FFS IVF program within the Kaiser Permanente (KP) HMO setting. DESIGN: Retrospective evaluation based on first-hand knowledge of clinic outcomes and management of a NFP REI practice and a FFS IVF program from January 2007 through May 2008. MATERIALS AND METHODS: Our goal in merging a NFP REI practice and a FFS IVF program was to provide a fuller spectrum of fertility services and continuity of care. Access: Focus on appointment (appt) demand, net loss and demand calculations allow for better appt utilization, access to services and decreased financial net loss. Quality: Quality standards from the IVF lab were established in parallel with the clinic side to maintain consistent quality practices. Staffing: Decentralization of IVF Case Management staff allows for a more consistent level of nursing care at local facilities, improved patient access, better service and physician satisfaction. Charting/Technology: Successful implementation of an electronic medical records program allows clinic to communicate patient information and improved standards of practice for REI and IVF throughout KP. Departmental re-structuring: New positions were developed to allow for a division of work, as well as better utilization of staff. Patient Satisfaction/Service: A variety of patient satisfaction surveys, service contests and team meetings for REI and IVF are used as quality care markers for ensuring consistent patient satisfaction and improved clinic efficiencies. RESULTS: With continued focus, our ability to deliver best practices for REI and IVF is evident by our clinical success rates, quality outcomes, viability of our program, in addition to KP's commitment to expanding both our REI and IVF services within KP. CONCLUSIONS: The nation's leading HMO, KP, has been able to continue to successfully integrate a viable FFS IVF program and NFP REI practice within the MC setting while maintaining the same level of quality, service and accessible personalized care for both.