Integrated health systems require integrated Medical Management Programs to be successful . . .
"It was clear that to be truly successful in managing shared risk contracts we needed an affordable medical management program that would address a patient’s entire medical care experience, whether it be in the doctor’s office or the hospital’s facilities. The program that The Tompkins Group helped us design is now being implemented."
Russell Munson, M.D.
Medical Director
Integrated Resources of the Middlesex Area, LLC
Middletown, Connecticut
IRMA (Integrated Resources of the Middlesex Area, LLC) is the managed care contracting organization of Middlesex (Connecticut) Hospital and its physicians. As IRMA began to negotiate risk-sharing contracts with HMOs, its leadership recognized the need to implement a cost-effective Medical Management Program. This meant merging Quality Improvement (QI) and Utilization Management (UM) functions separately administered by the hospital, IPA, home health and other providers, and contracted health plans. A major objective was to prevent duplication of effort and resources and to ensure quality and utilization issues were monitored and addressed wherever patients received their medical care.
The Tompkins Group teamed with The Pace Group of Dallas, Texas, to develop a business plan for an integrated Medical Management program tailored to meet IRMA’s needs. The plan included inter-organizational governance, committee charters, staffing levels and job descriptions, financial projections, and a detailed implementation plan. The program was designed to meet state, federal and accrediting agency (JCAHO and NCQA) requirements and HMO standards for delegation of program authority.
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