AUTOMATED MONITORING FOR HMO QUALITY ASSESSMENT

SCHALLER ASSOCIATES, INC.'S LONG-TERM OBJECTIVE IS TO IMPLEMENT AN EFFECTIVE, AUTOMATED, QUALITY MONITORING PROGRAM FOR HEALTH MAINTENANCE ORGANIZATION (HMO) ADMINISTRATORS. THE PROGRAM WILL GENERATE REPORTS ON PROFILES OF CARE, IDENTIFY EXCEPTIONS TO NORMS, BE PORTABLE TO ALTERNATIVE HMO SETTINGS, BE USABLE BY NURSING AND SUPPORT STAFF, AND WILL HAVE A SIGNIFICANT AND LASTING IMPACT ON QUALITY ASSESSMENT PROCEDURES IN THE HMO INDUSTRY.PHASE I WILL PRODUCE A FIELD-TESTED PLAN DESCRIBING THE MINIMUM SET OF DATA ELEMENTS RE REQUIRED, THEIR SPECIFIC SOURCES, AND THE RELEVANT INSTRU- MENTS, PROCEDURES, AND RESULTING REPORTS. COMPONENTS OF THESYSTEM WILL INCLUDE AN ENCOUNTER DATA SYSTEM, A MEMBER IN- FORMATION SYSTEM, GRIEVANCE/COMPLAINT AND CLIENT-ADVOCATE SYSTEMS, AND HEALTH OUTCOMES PROTOCOL. A TECHNICAL ADVISORYCOMMITTEE WILL ASSIST IN DEVELOPING THE PLAN, WHICH WILL THEN BE FIELD TESTED AT THREE SITES, INCLUDING A GROUP, AN IPA, AND A STAFF-MODEL HMO. PHASE I WILL PROVIDE A FEASIBILITY-TESTED FOUNDATION FOR PHASE II DEVELOPMENT OF COMPUTER SOFTWARE AND DOCUMENTATION HANDS-ON IMPLEMENTATION AT SELECTED HMO TEST SITES, AND EF- FORTS TO INSURE ACCEPTANCE OF THE PROGRAM THROUGHOUT THE HMO INDUSTRY. SCHALLER ASSOCIATES, INC. WILL THEN MARKET THE PRODUCT COMMERCIALLY AND PROVIDE USER SUPPORT.