Project Examples
UTILIZATION MANAGEMENT
Marin General Hospital
Greenbrae, CA
Situation
Marin General Hospital, an affiliate of Sutter/CHS, having recently undergone an organizational restructuring with a major national consulting firm, continued to need restructuring of the Utilization Review/Discharge Planning department.
Solution
CQI designed, developed and facilitated a transition from a fragmented UR/DCP process to a Case Management Department system, using zero-based budgeting principles.
Outcome
Marin General Hospital, over a six-month contract period, transformed from a reactive-focused department to a proactive, systematic, resource conservative, Case Management process, streamlining patient care, maximizing utilization staff efficiency, and increasing payer source revenue.
QUALITY MANAGEMENT
Santa Clara County Valley Health & Hospital
System
San Jose, CA
Situation
Santa Clara County, Department of Alcohol & Drug Services experienced a significant growth in Alcohol and Drug Services use by County residents with fragmented services from contracted private and County providers.
Solution
CQI designed and developed a managed care program including a gatekeeper data entry point, building Quality Management processes through Case Management program design and training, NCQA compliant indicators, Quality Management Manual and Process Improvement Plan, team facilitation, customer service surveys and data-driven organizational development techniques.
Outcome
Santa Clara, over a year and a half contract period, transitioned from a quality fragmented fee-for-service program to a fully-integrated, Disease Case managed health services program, focusing on data-documented improved County processes of care, significantly improved provider participation and communication, increased resident access to services at the appropriate level of service and improved NCQA compliant outcomes.
CASE MANAGEMENT
ProAct E.A.P
Amarillo, TX
Situation
ProAct E. A. P. requested assistance in transitioning from a traditional employee assistance referral program to a full-service employee targeted catastrophic healthcare Case Management services company.
Solution
CQI performed an assessment of existing structure and processes and developed a strategic concept of the transitional needs and facilitated the client's decision to develop the process internally.
Outcome
ProAct E. A. P., over a 3 month contract, capitalized on the existing structure strengths identified by the CQI assessment to transition to a full-service employer Case Management program, locating resources, information systems and training information, expanding market base, client referrals and revenue.
DISEASE MANAGEMENT
Baxter Healthcare Corporation, Inc.
Chicago, IL
Situation
Baxter Healthcare Corporation Inc., world renown for quality renal management medical products, requested assistance in developing an End Stage Renal Disease Management program.
Solution
CQI assessed current design, promoted synergistic relationships between independent components through team facilitation activities, and developed a homogeneous national Renal Disease Management system, including development of key operational components, such as process of care algorithm mapping, human resource structures, case management function definitions and position descriptions, Utilization and Quality Management structure and manuals, and information technology systems selection.
Outcome
Baxter Healthcare Corporation Inc., after a 9 month contract, launched a new subsidiary, Renal Management Strategies, which further expanded revenue value-added options built on a world renown reputation of providing manufactured dialysis products and which resulted in two nationally regarded health plan contracts for End Stage Renal Disease Management services.
CQI
A HEALTHCARE MANAGEMENT SERVICES COMPANY
Julia A. Rieve, RN, BSHCM, CCM, CDAF, CPHQ, FNAHQ
President
2726 Shelter Island Drive, Suite 316
San Diego, CA 92106
619-226-4141 VM & FAX
Send Inquiries & Comments to: rieve@CQIhealthcare.com