Standards for private organizations

2020 Edition

Network Administration (NET) 2: Network Organization

The network management entity organizes individual network members, community partners, and other network participants into an integrated delivery system.
2020 Edition

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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.
1
The organization's practices fully meet the standard, as indicated by full implementation of the practices outlined in the NET 2 Practice standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the NET 2 Practice standards.
3
Practice requires significant improvement, as noted in the ratings for the NET 2 Practice standards.
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the NET 2 Practice standards.
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Network communication procedures
  • List of network provider organizations and individual providers including the network services they provide
  • Grievance/complaint procedures for network service providers
  • List of Advisory Body members and affiliations
No On-Site Evidence
  • Interviews may include:
    1. Managing entity CEO
    2. Network advisory body
    3. Governing body
    4. Directors of organizations that contract with the managing entity
    5. Independent practitioners
    6. Persons served/community stakeholders

NET 2.01

The network management entity is structured such that:
  1. the unique contributions and different goals that each network participant may bring to the common endeavor can be recognized; and
  2. the network management entity’s business goals can be reconciled with the members’ ethical and mission-driven interests.
1
The organization's practices reflect full implementation of the standard.
2
Practices are basically sound but there is room for improvement.
3
Practice requires significant improvement.
4
Implementation of the standard is minimal or there is no evidence of implementation at all.

NET 2.02

Integrating network management entity functions include:
  1. a process that ensures ease of entry into a system of highly accessible services;
  2. agreed upon quality improvement expectations for the network as a system;
  3. uniform utilization and management protocols; and
  4. 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.
1
The organization's practices reflect full implementation of the standard.
2
Practices are basically sound but there is room for improvement.
3
Practice requires significant improvement.
4
Implementation of the standard is minimal or there is no evidence of implementation at all.

NET 2.03

Clear communication throughout the network to network providers, persons served, and payors, as applicable, is facilitated through a system that:
  1. provides all parties with the information necessary to operate effectively;
  2. facilitates clear understanding of mutual expectations for all parties; and
  3. describes a mechanism for the resolution of conflicts, including conflicts of interest, among member entities and/or community partners.
1
The organization's practices reflect full implementation of the standard.
2
Practices are basically sound but there is room for improvement.
3
Practice requires significant improvement.
4
Implementation of the standard is minimal or there is no evidence of implementation at all.

NET 2.04

The network management entity maintains a formal mechanism through which provider organizations and independent practitioners can express and resolve complaints and grievances, including:
  1. denial or termination of the clinical privileges, including of individual service providers within owner and provider organizations;
  2. decisions not to contract with providers;
  3. decisions to abrogate contracts with providers;
  4. the network management entity’s referral practices; and
  5. claims payments.
1
The organization's practices reflect full implementation of the standard.
2
Practices are basically sound but there is room for improvement.
3
Practice requires significant improvement.
4
Implementation of the standard is minimal or there is no evidence of implementation at all.

NET 2.05

The network management entity maintains a stakeholder advisory group that serves as a bridge to the community, and it:
  1. includes representatives of relevant community groups, consumers, service providers, advocates, and others with an interest in the success of the network achieving its mission or purpose;
  2. provides information and feedback about services, outcomes, the perception of the network within the community, and other information that would help the network better serve its defined population and the community; and
  3. serves in an advisory capacity only and does not assume governing body or management responsibilities.

Interpretation

 In order for advisory groups to function well the network management entity should:
  1. establish clear and transparent recruitment and selection guidelines;
  2. have reasonable expectations about what the group can accomplish within the parameters of its mission and available resources; and
  3. actively consider and respond to the group's input, feedback, or recommendations.
1
The organization's practices reflect full implementation of the standard.
2
Practices are basically sound but there is room for improvement.
3
Practice requires significant improvement.
4
Implementation of the standard is minimal or there is no evidence of implementation at all.