We are pleased to offer a network of occupational therapy providers to health plans, payers, administrators and employers. The profession of occupational therapy continues to be a vital piece in the rehabilitation of individuals with limited function. We are pleased to provide you with additional information about the Evolent occupational therapy network.
Each Evolent network is comprised of the following areas:
- Network Development
- Quality Management
- Utilization Management
Network Development includes the creation of a network and the continual review of its adequacy. Evolent works closely with the payer, health plan, administrator or employer to fulfill their needs for geographic concentration to maximize access and choice of providers for their consumers. This also includes initial provider contracting, summary provider manual and continual provider communications.
Quality Management initiates through the credentialing process. Magellan follows a defined process to ensure quality providers who are appropriately educated, licensed, and not restricted from providing care. This includes application completion, primary requirements and licensure. See the prospective provider application if you are interested in becoming an occupational therapy provider.
This area also includes measurement of quality, satisfaction and outcomes. Patient satisfaction is measured with a modified Consumer Assessment of Health Plans Survey (CAHPS). A random sample of patients will receive the satisfaction survey and an outside agency will handle the mailing, data collection and reporting. This survey also includes questions to monitor functional outcome and quality of the services provided.
Utilization Management includes treatment guidelines and care management review. The occupational therapy treatment guidelines were developed following a thorough literature review and consensus based practitioner discussions to create an evidence-based guideline. They include treatment indicators and utilization guidelines.
Reporting will include regular review of the measures discussed above as well as cost and frequency of care provided. These reports are intended to be feedback for providers as well as opportunities for comparison with similar providers.