Quality in managed care: developments and considerations.
With the rapid movement of both individuals and groups away from fee-for-service health care into managed care, concerns have been expressed appropriately that the quality of care may be affected adversely. Over the past several years, a number of developments have taken place to respond to these concerns. This quality movement in managed care has not been without some issues and considerations, however. This article first describes the National Committee for Quality Assurance (NCQA) and the prominent role it has played in this movement. Next, quality improvement study design is addressed in the context of assuring quality, controlling costs, and achieving NCQA accreditation. The effect that capitation, as a payment strategy for providers, has on data quality is then described. Fourth, the value of partnering is explored. Finally, the newest version of NCQA's performance measurement template is discussed: the Health Plan Employer Data and Information Set, version 3.0.
Spoeri
R K
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NYLCare Health Plans Inc, New York 10006, USA.
D000068:Accreditation; D002204:Capitation Fee; D003363:Cost Control; D019468:Disease Management; D019538:Health Care Surveys; D006801:Humans; D008329:Managed Care Programs / Q000191:economics / Q000592:standards*; D008485:Medical Audit; D009938:Organizations; D011785:Quality Assurance, Health Care / Q000191:economics / Q000458:organization & administration*; D014481:United States