Select Quality Care Professional supports a wide variety of decision-making activities in the contracting, network development, finance, marketing and quality improvement areas of managed care organizations. Specifically, Select Quality Care Professional can be used for:

• Understanding a hospital's performance compared to peer hospitals and best practices
• Comparing severity-adjusted charges, cost and LOS across hospitals by service line
• Understanding physician performance for inpatient care in comparison and benchmarks
• Aligning pay-for-performance incentives with quality
• Evaluating hospitals for network inclusion on the basis of quality and cost
• Identifying centers of excellence for specific product lines and high cost procedures
• Modeling the effect of different reimbursement approaches (e.g., per diem, per case type) on hospital profitability

Improve Network Management and Design

Select Quality Care Professional can be used to define a market area and identify the appropriate hospitals for analysis, rank the hospitals by severity-adjusted cost and quality, separate hospitals into performance tiers and quantify the savings if volume were to be shifted to high-quality, low-cost hospitals.

Identify Centers of Excellence for Specific Product Lines

Select Quality Care Professional enables payers to identify Centers of Excellence for specific inpatient treatments — such as bariatric surgery, transplants, cancer care and tertiary pediatric services — using volume, cost and quality information.

Model Contract Terms and Determine Hospital Profitability

Model the effect of current and contemplated contract terms on specific hospital profitability in total or by hospital service. Incorporate per diems, case rates, capitation, stop-loss provisions and other methodologies into the analysis. Compare your rates with rates under Medicare reimbursement by hospital.

Better Prepare for Contract Negotiations

Before you begin contract negotiations, make sure you have a comprehensive understanding of how each hospital in your network performs. With Select Quality Care Professional, you can go beyond your own claims data to obtain an in-depth, severity-adjusted hospital cost and quality performance profile that incorporates both outcomes and process measures. Select Quality Care Professional also allows you to drill down into the details of a hospital's performance by service line, procedure and more.

Make Meaningful, Severity-Adjusted Benchmark Comparisons

Select Quality Care Professional expands your ability to measure and compare the performance of hospital-based services to state, national or customized benchmarks based on resource use and quality measures. Provider performance is compared to benchmarks calculated at each level of risk and severity, taking into account the difference in case mix from one provider to another.