Subject matter experts: building a reservoir of available research
To assemble and build on the available evidence-based-care research, we engage practicing, board-certified physicians who possess clinical expertise in the respective guidelines' domain, such as sleep medicine and radiology. These physicians serve as subject matter experts (SMEs) and contribute in several ways. For example, they couple their expertise as practicing physicians with analysis of primary literature, specialty society guidelines, and technology assessments.
Specialty review panels: supporting guideline development
The formal governance of guideline development begins with specialty review panels. Chaired by one of our solution medical directors, each panel includes at least three board-certified physicians with expertise in relevant specialties. We select the panelists based on their proficiency in the clinical specialty or in health care research. Like our SMEs, our panelists perform numerous tasks: they assist with drafting guidelines, offer counsel on particular guidelines, and provide recommendations to the independent multispecialty physician panel.
Independent multispecialty physician panel: reviewing and approving guidelines
The independent multispecialty physician panel is an autonomous group that has final-decision-making authority for approving guidelines. The panel consists of at least seven board-certified practicing physicians and represents various regions, specialties, and practice settings. This multidisciplinary approach balances the input integrated in the development process, especially in regards to primary care, specialist, and subspecialist referral patterns and patient considerations.
the right care
Our clinical appropriateness review model is focused on achieving the right care for the patient the first time and effectively avoids unnecessary disruption. Rather than simply denying requests for care that doesn't initially appear to meet clinical criteria, we provide educational opportunities and transparency to the physician community as part of the clinical intake process, and through peer-to-peer consultations. Prioritizing efficient provider interactions and education leads to sustained behavior change, reduced care variation, significant savings, and high provider satisfaction.
Medicine advances at a fast pace. Our team is actively engaged in reviewing, discussing, and analyzing medical advancements, breaking news, and new technologies. Moreover, we constantly examine our processes and tools to find ways to create new value for health plans, their members, and their providers.
Our approach to innovation:
AIM possesses the footprint and resources for you to introduce value-based reimbursement throughout your entire provider network.