Measurement and management of quality in managed care organizations: alive and improving.
Leatherman et al, Schlackman, and McGuirk-Porell et al all provide important examples of how managed care organizations (MCOs) will measure quality in this decade (except for health care status, which none have yet incorporated). All three organizations rely on insurance claims as a data source and quality management as a tool for improving quality; United Health Care and US Health-care use claims data to improve care for the entire membership, a still unrealized potential for MCOs. All three programs, relatively new, can be only minimally evaluated in terms of measurement validity, cost-efficiency, and improvement in the quality of care. The impact of such MCOs depends on policy initiatives, improvements in outcome and process measures, and MCOs' commitment to serve the total population, including the uninsured and Medicaid populations.
Goldfield
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3M/Health Information Systems, Wallingford, CT 06492-7507.
D006302:Health Services Research / Q000379:methods; D006801:Humans; D007345:Insurance Claim Review; D008329:Managed Care Programs / Q000458:organization & administration / Q000592:standards*; D008332:Management Quality Circles; D010818:Practice Patterns, Physicians'; D011785:Quality Assurance, Health Care / Q000592:standards*; D012051:Reimbursement Mechanisms; D012308:Risk Management; D014481:United States