	Network Administration

Introduction

Administration and Management

Service Delivery Administration Standards

Service Standards

PA-NET 2: Network Organization

The network organizes individual network members, community partners, and other network participants into an integrated delivery system.

PA-NET 2.01

The network is structured such that:

the unique contributions and different goals that each network participant may bring to the common endeavor can be recognized; and
the network’s business goals can be reconciled with the members’ ethical and mission-driven interests.

PA-NET 2.02

Integrating network functions include:

a process that ensures ease of entry into a system of highly accessible services;
agreed upon quality improvement expectations for the network as a system;
uniform utilization and management protocols; and
a system for managing information that integrates network operations and network participants’ information, including key costs, performance data, outcome indicators, and member or consumer satisfaction data.

PA-NET 2.03

Clear communication throughout the network to network providers, persons served, and payors, as applicable, is facilitated through a system that:

provides all parties with the information necessary to operate effectively;
facilitates clear understanding of mutual expectations for all parties; and
describes a mechanism for the resolution of conflicts, including conflicts of interest, among member networks and/or community partners.

PA-NET 2.04

The network maintains a formal mechanism through which provider organizations and independent practitioners can express and resolve complaints and grievances, including:

denial or termination of the clinical privileges, including of individual service providers within owner and provider organizations;
decisions not to contract with providers;
decisions to abrogate contracts with providers;
the network’s referral practices; and
claims payments.

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	PURPOSE: Network services are delivered to a defined population through an integrated network of providers with the goal of ensuring optimal access, quality of care, and consumer satisfaction.

RELATED FILES


	SERVICE One or more organization-operated programs or activities that have a common general objective and deploy the organization's material and human resources in a planned and systematic manner. An organization that publicly promotes or identifies itself in writing as offering a service, is licensed to deliver a service, assigns personnel and/or space to a service, or allocates financial resources to a service is considered to offer that service.


	QUALITY In this context, the extent to which contemporary and generally recognized standards for professional practice are met and exceeded, and desirable service outcomes achieved.


	CONSUMER The individual, family, group, or community that seeks or receives services.


	COMMUNITY A specific group of people living in the same locality and who may share a common culture, values, and norms. Communities can also be defined by race, religion, ethnicity, age, occupation, political status, tribal affiliation, interest in particular problems or outcomes, or other common bonds. The term "community" encompasses worksites, schools, tribes, residential neighborhoods, business districts, recreational areas, and health and human service sites.


	PROTOCOLS Instruments and procedures used to accomplish a particular goal, activity, or purpose.


	PERFORMANCE A measure of how well an organizational system provides services to consumers. Performance is often based on key indicators, such as rates of service, cost per consumer, degree of satisfaction with services, and extent of consumer access to services.


	INDICATOR A described activity, event, outcome, or benchmark used for measurement in monitoring the quality and outcome(s) of service.


	COMPLAINT An expression of verbal or written dissatisfaction that can include, but is not limited to, services, manner of treatment, outcomes, or experiences. For employees or volunteers, dissatisfaction can include personnel matters such as supervision, evaluations, promotions or demotions, the work environment, and overall treatment. The term is synonymously used with GRIEVANCE.


	CLINICAL The study, assessment, and diagnosis of the client situation followed by direct treatment to help the client achieve prescribed goals.


	CONTRACT A formal written agreement between two or more parties that specifies the services, space, or products to be provided in exchange for some form of compensation. Also known as "purchase of service arrangement."


	MANAGEMENT See ADMINISTRATION


	GRIEVANCE See COMPLAINT


	TERMINATION See CASE CLOSING


	PRACTICE Established actions or ways of proceeding in the regular performance of organizational duties. Policies and procedures often guide practice.