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Medical Management
The Hartford Physician Hospital Organization (HPHO) Medical Management Program performs a core function of the organization.
The HPHO Medical Management Program coordinates, directs, and monitors the quality and effectiveness of health care resource utilization through identification, analysis and recommendation of more efficient patterns of clinical and administrative practice. The program is committed to nurturing and facilitating the medical management capabilities of its individual physician members, and Medical Groups. The HPHO Medical Management Program is committed to achieving and documenting improved health outcomes for its covered lives. In order to fulfill these duties the HPHO must hold a license with the State of Connecticut in Utilization Management. There are rigorous infrastructure and reporting requirements associated with the maintenance of the license.
The HPHO has now added nursing case managers who are dedicated to Clinical Integration and Disease Registry initiatives in support of Hartford Hospital, payer specific programs, and physician members that participate in the expanding Disease Registry.
Other essential components of the program include:
- Collaboration with payers on delegation of Utilization Management activities
- Maintaining a Medical Management Committee that serves as the governing body for Medical Management oversight
- Reviewing and formalizing the HPHO’s Disease Registry Guidelines
- Determining, reviewing, and approving of inpatient stay criteria. The HPHO and Hartford Hospital jointly utilize McKesson InterQual® criteria. These criteria are reviewed annually by the Medical Mangement Committee. Click here to see the most recent notification
- Establishing any local exceptions to the inpatient criteria
- Reviewing decision making practices of those Care Continuum staff making inpatient stay decisions and assisting the coordination of discharge planning. Continuity validation of that decision-making process is done through the HPHO’s annual Inter-rater Reliability Study
- Annually measuring the satisfaction physician members have with the utilization management process and the Care Continuum Department nurse's performance
- Maintenance of payer delegation Utilization Management status through annual oversight audits
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