Healthcare Compliance, Quality & Safety | Quality Review

Gain a clear picture of provider quality and performance

Monitor, benchmark, and report on provider performance using automated workflows for peer review, OPPE, and FPPE. Convert hard-to-manage paper processes into automated workflows for a repeatable, defendable peer review process—maintaining strict control over the quality measures that affect your reimbursement.
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The average cost to perform physician quality reviews 2x per year, as required by The Joint Commission, is just under $300,000 for peer groups of 20-100 providers.

Using data analyzed from symplr's quality solutions

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Where does your provider quality stand?

Healthcare has traditionally been based on fee-for-services (FFS) models, where a provider performs a service and is paid accordingly. With FFS payment models, providers have little incentive to demonstrate quality improvement to payers.

Healthcare is shifting to value-based care where revenue and reimbursements are directly tied to quality of care and patient outcomes. In a survey of 102 healthcare executives, a majority of respondents stated at least 25% of their revenue is tied to value-based payments—with over half saying value-based payment will be the dominant revenue model in the next five years.

Quality metrics lead to better negotiating power with payers when benchmarks are exceeded, leading to better reimbursement rates. symplr’s cloud-based provider quality software tools deliver the comprehensive provider quality reporting and monitoring you need for all quality improvement initiatives.

From initial onboarding to CMS accreditation measurements to value-based payment reporting and outcomes, Quality Review pulls the information you need into actionable dashboards, enabling you to focus your time and energy on the most critical provider issues.

Helping you navigate the complexities of provider performance improvement

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Achieve performance-improvement focused peer review
Drive optimal patient outcomes—and provider success—with your evaluations, to achieve true quality improvement. Track privilege use and trend quality indicators: CMS core measures, TJC core competencies, and more. Determine when to send an FPPE to peer review, or include it in an OPPE report or any improvement plan.
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Move past paper forms and reporting
Automate workflows, give reviewers convenient online permissions-based access to files, and achieve a repeatable, defendable quality review process every time. Guide departments, reviewers, individuals, or committees with role-based, configurable, automated workflows. Set assignments by location, department, issue type, or indicator.
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Satisfy audits and compliance requests
Quickly satisfy auditing requests to The Joint Commission, DNV, HFAP, and CIHQ. Leverage ready-to-run, built-in reports that satisfy both discoverable and non-discoverable state statutes, to meet attorney and auditor requests.

Comprehensive, cloud-based provider quality improvement

Peer Review
Our peer review software converts your mapped paper policies to an automated configurable workflow, enabling you to maintain a consistent standard for peer review across all departments, and ensures everyone adheres to defined policies and procedures. Peer review events will no longer end up abandoned; you will have complete visibility into the current status and to-do list for each event.
Professional Practice Reporting
Professional Practice Reporting is an automated, cloud-based solution that enables you to track physician privileges to procedures performed and quality indicators: CMS Core Measure Indicators, OPPE, The Joint Commission Core Competencies, and more. Gain valuable insight to ensure your patients receive the highest quality of care. It not only tracks competency, but also tracks performance of the competency. Tracks actions taken and outcomes to assist in demonstrating performance improvement for Value Based payment incentives and to avoid penalties.
Quality Issue Manager
symplr’s Quality Issue Manager is a workflow and reporting solution for managed care plans and provider networks. Track any grievance or complaint from inception to outcome. Your crucial quality data identifies when an employee or provider has crossed a threshold, jeopardizing quality —or helps you recognize an individual’s positive contribution to your patient population.

Control the quality measures affecting your reimbursement and patient populations

From initial onboarding to CMS accreditation measurements, to value-based payment reporting and outcomes, symplr Quality Suite of solutions pulls the information you need into actionable dashboards so you focus your time and energy on the most critical provider issues.
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Resources

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Overview
Quality Review
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eBook
The Complete Guide to Performance Improvement Focused Peer Review
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Blog
How to Revive Your Healthcare Quality Assurance Program Post Pandemic
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