CareConnections

Northwest Rehab Alliance (NWRA) instituted the use of a unique web-based quality and utilization management system developed by Therapeutic Associates Inc. (TAI) / CareConnections to serve its largest payer customer, Regence of Oregon. NWRA requires its member therapy providers to register their new Regence patients in a Prior Advice System (PAS) which provides immediate advice as to the number of treatments the provider should target per diagnosis. The recommended treatments are based upon the Therapeutic Associates Inc. (TAI) Clinical Practice Guidelines: Examination and Intervention for Rehabilitation. The guidelines have been adopted by NWRA, an independent practice association of therapy providers serving the managed care needs of Northwest payers, as their benchmarks for frequency, duration and appropriate utilization of therapeutic modalities and procedures.

Working collaboratively with payers is a goal of NWRA. Using claims data provided by Regence, NWRA matches PAS registrations to the dollars paid to member providers. The data collected allows NWRA to profile its members' utilization of services and compare their performance to the guideline benchmarks. NWRA also collects outcomes information using another TAI CareConnections product, the Therapeutic Associates Outcomes System (TAOS), to further define the value of services rendered to its payer customers like Regence. Analysis has shown that utilization of services has remained within the treatment parameters set forth in the guidelines, while quality of services has remained consistent with national norms.