Simply determining that a member needs a particular service will not ensure positive outcomes.
Determining the congruence of care with industry standards
Efficacy depends on a match between clinically appropriate services and clinical need. Effective utilization review programs transcend client ‘utilization review’ by equally measuring field-tested quality and evidence-based standards of care.
Fidelity monitoring measures the match between provider or provider groups and industry/ EBP standards of care for specific conditions or diagnoses. DDM Ascend incorporates evidence-based and accepted industry standards for healthcare across all phases of program management. Our utilization management clinicians are:
- Up-to-date on state-of-the-art therapeutic interventions and other industry/evidence-based standards of treatment
- Trained and supervised to educate providers and measure delivery of evidence based treatment standards
- Trained to carefully assess client progress and relative match of appropriate evidence-based interventions based upon diagnostic need indicators
We also incorporate fidelity measures in onsite quality monitoring, provider training, procedures, and virtually all phases of project management.