symplr’s Quality Issue Manager provides managed care organizations (MCOs) and provider networks with an easy-to-use, web-based interface to collect accurate, timely, comprehensive member issues data. This two-part software product then refers provider management issues to a configurable Peer Review Workflow tool, if warranted, for evaluation by nurse reviewers or medical directors.
Quality data is your best tool to identify an employee or healthcare provider who has crossed a threshold, costing the organization revenue loss or jeopardizing quality and patient safety. The data can also highlight individuals making a positive, lasting contribution to your patient populations served.
Shared savings programs, peer review, participation on payer panels, provider performance—it all starts with tracking and managing quality issues data.
Issue Report software tracks initial details and indicators from a grievance, complaint, or commendation through to outcome.
As updates occur, send real-time notifications and assignments, configurable by location, department, issue type, or even by specific indicator.
Designated users—departments, individuals, committees, or reviewers—anywhere in the organization manage the review or evaluation process online and document the investigative steps taken.
Easily pass cases that require medical review to the Quality Review Workflow solution. It accepts information, notifications, and data from the assigned issue manager regarding a provider. Based on role, each designated user accesses unique tasks, letters, and forms in an automated workflow. Cases flow from one workgroup to the next until completion while alerts ensure no step or task is missed.
Robust analytics in Standard Issue Manager Reports demonstrate how each step in the process adhered to your organizational or accreditor’s policies, guidelines, and bylaws. Report on any workflow steps or the final outcome, including reason and criteria for inclusion, to support your need to produce: