Permedion can conduct special external and independent healthcare reviews as needed for institutional based care.

Focused reviews allow our clients the opportunity to take a closer look at issues that may arise out of the precertification review program, retrospective review program, quality of health care studies, or come to their attention through any number of sources (e.g. consumer complaint, legislative inquiry, other program integrity initiatives).

An example of a focused review would be a provider that resubmits a large number of claims with codes that have been upgraded. Permedion's review consists of comparing the medical record with the claims data. Another example of where a focused review would be helpful would be a provider that shows questionable transfer practices from one level of care to another level of care. The methodology used for focused reviews would be customized to fit the organizations utilization management objectives, and permit focused reviews of either a physician or an institution.

Permedion staff is available to participate in designing focused review projects through data analysis, targeting, and sampling. The size and scope of the focused reviews will vary depending on the nature of the issue necessitating the review.

Quality studies are a vital component of maintaining an ongoing strategy to improve the value of health care. Studies will support efforts towards increasing quality of care, improving beneficiary access, and reducing costs. Specific study topics can be developed in collaboration with your Health Care Quality Coordinating Committee.

Permedion will work with you to conduct studies, share tools, or coordinate analysis with other contractors. Clinical outcomes based studies can be developed to evaluate the quality of care delivered to managed care plan enrollees and to compare outcomes by managed care plan. Permedion will retrieve medical records for analysis, or survey individual patients about their outcomes. Our client will compare the results of quality reviews and coordinate improvement activities across delivery systems (managed care and fee-for-service). Permedion can assist with the development of a plan for external and independent health care quality studies.

Permedion will make recommendations which may include:

Permedion can assist with the development of a plan for health care studies.

The source of data for the health care studies will be medical records, administrative data, surveys, or a combination of the three. Eligibility data, fee-for-service claims data, and managed care encounter data will be provided by the client.

Permedion can sample the administrative data for the health care studies to determine which medical records to request, can request the records from institutional and physician providers, and can abstract the data needed to complete the study from the records. Medical record reviews can be performed at the provider’s site or copies of the records can be sent to us.

Permedion will use qualified surveyors, provide training for the surveyors in data abstraction, and measure inter-rater reliability. We will also select a sufficient sample of medical records and provider sites to assure valid studies. Permedion provides independent and external data collection and sampling.