How can you monitor the performance of your managed care organization?

1 Define your objectives and standards

Before you can monitor your performance, you need to define what you want to achieve and how you will measure it. You should align your objectives and standards with the mission, vision, and values of your MCO, as well as the expectations and needs of your stakeholders, such as members, providers, regulators, and payers. You should also consider the external benchmarks and best practices in your industry and market. Your objectives and standards should be SMART: specific, measurable, achievable, relevant, and time-bound.

2 Choose your indicators and data sources

Once you have your objectives and standards, you need to choose the indicators and data sources that will help you track and evaluate your performance. Indicators are quantitative or qualitative measures that reflect the quality and performance of your MCO in various domains, such as clinical outcomes, member satisfaction, provider network adequacy, financial viability, operational efficiency, and compliance. Data sources are the sources of information that provide the values for your indicators, such as claims, surveys, audits, reports, and records. You should select the indicators and data sources that are valid, reliable, relevant, timely, and feasible.

3 Collect and analyze your data

The next step is to collect and analyze your data according to your indicators and data sources. You should have a clear and consistent data collection plan that specifies the frequency, methods, and responsibilities for gathering and verifying your data. You should also have a data analysis plan that specifies the techniques, tools, and models for processing and interpreting your data. You should use descriptive and inferential statistics, as well as graphical and visual methods, to summarize and display your data. You should also compare your data with your standards and benchmarks to identify gaps and trends.

4 Report and communicate your results

After you have collected and analyzed your data, you need to report and communicate your results to your stakeholders. You should have a report format and template that presents your results in a clear, concise, and comprehensive manner. You should also have a communication strategy that determines the frequency, channels, and audiences for sharing your results. You should use different formats and methods, such as dashboards, newsletters, presentations, and meetings, to communicate your results effectively. You should also highlight your achievements, challenges, and opportunities for improvement.

5 Implement and monitor your actions

The final step is to implement and monitor your actions based on your results. You should have an action plan that outlines the specific actions, responsibilities, timelines, and resources for improving your quality and performance. You should also have a monitoring system that tracks and evaluates the progress and impact of your actions. You should use feedback loops, audits, and follow-ups to ensure that your actions are implemented correctly and achieve the desired outcomes. You should also review and update your objectives, standards, indicators, and data sources periodically to reflect the changes and needs of your MCO.

6 Here’s what else to consider

This is a space to share examples, stories, or insights that don’t fit into any of the previous sections. What else would you like to add?