quantumcare

Quantum Care’s Organ Transplant Program concentrates on providing affordable, quality, human-to-human organ transplantation for our clients. To achieve this goal, we have combined knowledgeable registered nurses and a centers of excellence program with a quality assessment program. The quality assessment program provides review prospectively, concurrently and retrospectively to ensure our clients receive the best care possible to suit their needs at the lowest possible price.

Most precertification/utilization review and case management firms have the expertise to identify potential transplant candidates, but do not have an experienced staff and access to facililties to carry out an appropriate level of medical management. Also, most payors and their case management firms are not familiar with the outcomes of the facilities, and appropriate pricing levels to manage the patient effectively. Without this knowledge a patient’s chances for survival may diminish while the cost for a transplant may be significantly increased.

Quantum Care works on a case-by-case basis. Our registered nurses will thoroughly evaluate the medical necessity for a transplant procedure, provide information and help the patient select an appropriate facility that meets their clinical and personal needs. We know that a facility’s history and the transplant team handling the case are the most important factor in the patient’s survival.

Quantum Care, through Strategic Health Development Corporation, has relationships with over 70 facilities for organ and bone marrow transplants. These relationships not only yield affordable rates for the medical care, they go beyond that to create a true working relationship with our Transplant Centers. Quantum Care strives to coordinate the appropriate care, facilitate the patient’s care and assure program compliance to avoid retransplantation.

Cost Containment

Savings generated are both ‘hard’ (fixed) and ‘soft’ (variable). There are annual contracts negotiated with providers that yield an immediate ‘hard’ savings, usually in the range of 20-40%. Our ‘soft’ savings, although more difficult to demonstrate, can yield as much if not more.

SELECTION OF PARTICIPATING FACILITIES

An essential component of this program is selective contracting with facilities that are recognized nationally and internationally for excellence in the specific area of transplant medicine. The primary components of this assessment program are:

q       Rigorous credentialing of each facility for specific transplant services. This includes the demonstration of:

-      All necessary facilities, services, and staff

-      Clinical outcomes

-      Minimal complication rates

-        Sufficient numbers of procedures that provide significant and ongoing

       experience for the team.

q       Only physicians affiliated with the facility that meet the contract defined credentialing process may provide care to Program patients. This process includes, but is not limited to, the following:

-     Unrestricted license to practice medicine in facility state

-     Active and unrestricted clinical privileges at the facility

-     Unrestricted prescribing privileges

-     Other requirements as agreed to by the facility

      as set forth in the contract.

Copyright © 2001 Quantum Care Inc. All rights reserved.
Revised: August 01, 2001