Physician Consortium & Clinical Quality
The Provider Resources, Inc. (PRI) Physician Consortium & Clinical Quality Division focuses on the evolving healthcare landscape and the need for quality metrics, performance measures, and quality indicators. As the nation is experiencing a convergence of sweeping legislation and advances in quality improvement and measurement science, we have positioned this division to provide clients with thoughtful, timely, effective, and efficient solutions for interpreting and implementing new healthcare regulation and program guidance. The Physician Consortium & Clinical Quality Division is a key resource to policy makers, educators, business leaders, healthcare stakeholders, and advocacy groups for the most accurate, timely, and useful information on defining, measuring, and improving the quality of care provided to disparate populations. Solutions are based on robust needs assessments, evaluation of existing manual and protocol guidelines, and available training materials. PRI subject matter experts (SMEs) infuse clinical quality integrity measures with three core directives:
- Deliver consistency with industry standards
- Accommodate the continued evolution of quality assessment
- Provide superior technical assistance
As healthcare legislation emerges, PRI clinical quality experts identify the standards impacted and look to identify the implementation opportunities and challenges for our federal clients. We use multiple approaches, such as stakeholder focus groups, survey development, and national data set reviews to identify and clarify the impact of legislative efforts. The ability to analyze programmatic data to generate innovative solutions has defined PRI based on efforts in maternal, child, and infant health (MICH) initiatives. MICH topics have included providing options for improving breastfeeding/human milk feeding to reduce the potential for neonatal comorbidities and generating comparisons between the Medicaid and commercial population outcomes, length of stay (LOS), and associated program costs related to preterm births.
Our team has extensive experience with complex survey and questionnaire design including formatting, flow, reading level, response scaling, and response nesting. We have developed survey questionnaires and data collection forms to assess population health status, patient satisfaction, adult and senior behavior, behavioral assessment, expectations and loyalty, medical illness, mental disorders, care seeking, attitudes, awareness, knowledge, preference, and intentions, as well as cost impact analysis to be utilized in agency development of Final Rule making. We have designed interviewer-assisted or self-administered survey questionnaires delivered through a variety of methodologies including in person, telephone, mail, internet, or mixed methods according to specified sampling (e.g., convenience, random, stratified, and quota).
PRI quality-based contracts have provided outreach for interviews, focus groups, and reviews. Examples of outreach efforts include over 55 comparative effectiveness research (CER) reviews, regulatory impact analyses including input from over 21 stakeholder groups, protocol revisions incorporating input from over 50 stakeholder groups, and development of a MICH-based collaborative with 23 State Medicaid offices. We have successfully applied data collection methodologies to increase non-response through innovative techniques .
As a URAC Accredited Independent Review Organization (IRO), PRI is entrusted with providing clinical oversight for appropriateness of quality care. For more information on our medical and legal expertise related to External Reviews and PRI’s Physician Consortium, please visit the links below.