To have supplementary health indicators to monitor and evaluate the quality of services provided by operators is one of the advantages of carrying out medical bill audit. It is a mandatory process that, once automated, generates many benefits for the organization itself, its patients and partners.

While for users and related providers, security and reliability increase, for the operators themselves, the management process is more efficient and the assistance provided becomes more qualified.

And to accompany this good management on a daily basis, Using the right indicators is essential as one of the strategic resources of healthcare providers.

In this post, we will introduce you to some of the indicators that you can monitor to ensure the quality of the services offered by your operator!

What are supplementary health indicators?

These indicators allow for analysis and examination of the performance of the supplementary health operator and its partners.

Thus, there is a real reflection of the situation of organizations at the moment, which favors the quantification of the care provided by health institutions to their beneficiaries.

ANS, the National Supplementary Health Agency, even has a policy to encourage quality improvement in the supplementary health sector through the IDSS.

Let's talk more about this indicator now.

What is the IDSS (Supplementary Health Performance Indicator)?

IDSS is a tool that aims to check quality assessment results in performance of supplementary health operators.

In a report presented annually, this indicator evaluates organizations according to four dimensions:

• Quality in Health Care, with a weight of 40%, in which there is an assessment of the set of health actions that contribute to meeting the health needs of beneficiaries, mainly prevention, promotion and assistance actions;
• Guaranteed access to plans, with a weight of 20%, which analyzes the coverage of the operator's provider network;
• Assessment of the operator's sustainability in the market according to its economic-financial balance, with a weight of 20%;
•  And finally, the process management and compliance with technical obligations and legal requirements of operators with regulatory bodies, also weighing 20% in this regard.

By annually judging operators within these criteria, considering the weights mentioned, a comparison between operators is made possible and this, in turn, increases competition in the market.

Consumers benefit as they now have an indicator that shows the most reliable and best quality operators through this ranking.

Here on our blog we have already brought four tips for you to improve your operator's IDSS. Check out: IDSS: UNDERSTAND WHAT THE SUPPLEMENTAL HEALTH PERFORMANCE INDEX IS

Indicators that your operatoryou can follow her to achieve even more quality

Now that we have talked about the IDSS and that this is also an indicator that your operator must pay close attention to in the search for high qualifications, we will mention four other indicators that can also be monitored by your management.

Hospital readmission rate

The first indicator we will address is how much beneficiaries need to be readmitted after completing training at a provider.

This rate shows how many of the users had the same illness, a similar illness, or even a complication, such as a hospital infection or damage caused by medical negligence due to a treatment carried out, during a period of thirty days following the procedure.

The quality of the service offered by the provider is evaluated and the lower this rate, the more satisfactory the success in terms of the quality offered.

Hospital stay rate

This indicator is calculated with the aim of indicating whether the beneficiaries are spending more and more time hospitalized or, on the contrary, are carrying out procedures with shorter duration over time.

Thus, it is possible to evaluate the efficiency of a given hospital unit and this can serve as a basis for carrying out planning, such as the number of beds needed to serve the population.

The assessment of this rate requires caution and an understanding of the context that the number represents because, for example, the increase in the average length of stay may indicate that patients are spending more time waiting for an exam or surgery or, also, recovering from infections. post-surgery.

Rate of non-compliant hospitalizations

When following an indicator that shows in numbers the non-conformities that occur during patient hospitalizations, critical points can be identified in this process.

From this, the reasons can be diverse.

Some recurring issues are the lack of necessary materialsfor proper treatment of the patient, lack of user identification, failure in communication between the reported opinion and the understood opinion, among many others.

And when this occurs frequently, it is an indication that the provider's hospitalization process is not being carried out with quality and that it requires attention.

Death rate

Last but not least, follow the death rate for each provider It is also extremely important for assessing the quality of partner institutions.

By studying this number, the variations that occur and the reasons behind each analysis carried out, it is possible to understand whether the services are being effective in treating patients' health.

Mapping the main critical points that led to death, since hospitalization, and identifying flaws in the processes to create and implement corrective actions is a duty of partners to reduce this rate.

Furthermore, preventive actions and discussions around this indicator can also cause this number to decrease over time.

Adopt a medical audit system cas a solution.

With software that automates the process of auditing medical service providers' accounts, it is possible to have a clear view for both sides (operators of each operator's manager, in addition to providing control and a significant reduction in unnecessary costs.

It's worth getting to know SAUDI, a medical bill audit system adopted by the largest healthcare providers in Brazil. With the aim of maintaining the “financial health” of health plan operators, SAUDI has already received several awards as the best solution for the supplementary health sector.

With our software, the audit process is automated, costs are reduced and we operate throughout the entire process, from authorization request to release for payment.

Contact Contact us right now and discover our personalized solutions for your well-structured GROWTH healthcare provider.