Plan Summary
The South Shore Physician Hospital Organization (SSPHO) was organized to develop a sophisticated approach to managing care for HMO's. The SSPHO allows physicians and the hospital to work together to provide high quality, efficient health care to the community. One important component of this health care delivery system is medical management.
Whether patients are in a managed care plan or not, it is clinically sensible to keep patients in a system of care where care plans can be influenced and outcomes tracked for the purpose of providing optimal care to the patients. This medical management plan incorporates all the elements of a managed care system that satisfy clinicians, patients, and employers by aligning the objectives of all.
The elements of the medical management plan for the SSPHO are:
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Across the continuum, proactive case management
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Referral and utilization review
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Comprehensive provider network
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Performance improvement activities
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Pharmacy/formulary development
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Extended care review
The benefits of this medical management are:
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Improves care delivery
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Fosters communication
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Provides patient-focused flexibility
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Provides physician oversight of program through structured committee and team meeting involvement
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Creates an evolving program responding to changes in the health care environment
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Places patients in the right setting at the right time
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Seeks creative and highly coordinated approaches to health care delivery that reduce unnecessary expenses and maximize quality