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Increasing formation of healthcare networks calls attention to quality guidelines

By Brad Contento, corporate communications, CARF International

Brad ContentoA major story so far in 2016 has been the change in service delivery models toward larger systems and networks through affiliations, mergers, and various other types of integrations. Providers are forming relationships across multiple sectors to expand their reach and provide services more efficiently to a broader population. The reasons are many. Networks help providers minimize risk by targeting known referral sources and referral destinations that consistently demonstrate strong fiscal performance and positive service delivery outcomes. Networks give providers an opportunity to coordinate services and share expertise and data. Networks also help providers move toward performance-based models of service delivery, thereby improving efficiency and quality, which is highly valued by payer sources.

This development is far from a surprise, with the increase in consolidation being a common “top trend” to look for in 2016 in articles published back in December and January. GE Healthcare Camden Group’s article titled Top Predicted Healthcare Trends of 2016, for example, was highlighted in our first quarter Aging Services Continuing Communication newsletter issue. The movement had already begun to pick up steam in previous years as U.S. providers responded to advances in patient record technology and components of the Affordable Care Act. Providers in many other countries are also responding to government changes in payment for services. These changes are part of a global demographic imperative that is putting increasing pressure on existing service delivery models that cannot be sustained.

For persons served, such trends might be good news. Integration of services, sharing of healthcare records and outcomes data, and closer relationships among providers contribute to keeping people out of inpatient settings and in their communities. But the rapidly changing environment poses challenges for providers as they find themselves operating within a new service infrastructure or environment. The trend toward networks is of particular interest to CARF because it poses quality questions for providers across the spectrum of industries in which we offer accreditation.

Although some organizations can acquire or merge with others to compete in this new environment, many will find it advantageous to pursue a different path to integrating services, based on establishing contractual relationships as part of a network. Organizations may function as either a “network administrator” or a “participating provider” within a network, and must coordinate along a myriad of operational links, including strategic and financial planning, resource management, technology integration, geographical expansion, and performance measurement. A provider’s currently implemented quality standards and guidelines may not sufficiently address these new, unique considerations for business and care functions across networks. In addition, regulatory and funding entities will be looking for indicators of the effectiveness and quality of these new network setups.

To help providers address these challenges, CARF has published new Network standards that are available as a complimentary download at www.carf.org/Accreditation/QualityStandards/OnlineStandards. The Network standards are a standards manual supplement that can be used in combination with all CARF standards manuals beginning in standards manual year 2016, effective July 1, 2016. In the context of the standards, a network is a legal entity that contracts with two or more organizations that deliver health or human services to persons served (“participating providers”) to coordinate functions between or on behalf of the participating providers. Various types of networks exist and they may have different purposes in the field. For example, business networks may be formed to establish strategic business arrangements with or among participating providers, and service delivery networks may establish an integrated system of service provision by participating providers to persons served. Other types of networks may combine the functions of business and service delivery networks. These new standards aim to help providers implement best practices concerning network leadership, responsibilities, and the general framework for how business and care functions should be addressed in these environments.

Networks must focus on ensuring quality among all of their participating providers. The accreditation process for networks recognizes that participating providers may not be individually accredited by CARF or another accreditation organization. Unaccredited participating providers can pose risk for a network, so the CARF network accreditation standards and process address this scenario. The standards define how networks can implement a regular, on-site quality review of unaccredited participating providers to ensure that practices related to policies and procedures, financial planning, safety, personnel training, emergency procedures, and more are reviewed for quality.

The new CARF Standards Manual Supplement for Networks replaces CARF’s previous Business and Services Management Network Standards Manual in its entirety. Aging services providers should note that the supplement also replaces the standards for Aging Services Networks previously included in the Aging Services and CCRC standards manuals. Questions regarding the Network supplement can be directed to your resource specialist.

5/31/2016
(Aging Services,Behavioral Health,Employment and Community Services,Child and Youth Services,Medical Rehabilitation)


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