Toward a 21st century quality-measurement system for managed-care organizations.
As the Nation's largest managed-care purchaser, the Health Care Financing Administration (HCFA) is working to develop a uniform data and performance-measurement system for all enrollees in managed-care plans. This effort will ultimately hold managed-care plans accountable for continuous improvement in the quality of care they provide and will provide information to consumers and purchasers to make responsible managed-care choices. The effort entails overhauling peer review organization (PRO) conduct of health maintenance organization (HMO) quality review, pilot testing a new HMO performance-measurement system, establishing criteria for Medicaid HMO quality-assurance (QA) programs, adapting employers' HMO performance reporting systems to the needs of Medicare and Medicaid, and participation in a new alliance between public and private sector managed-care purchasers to promote quality improvement and accountability for health plans.
Armstead
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RC
Office of Managed Care, Health Care Financing Administration, Washington, DC 20201, USA.
Elstein
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P
Gorman
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D002204:Capitation Fee; D014487:Centers for Medicare and Medicaid Services, U.S.; D006302:Health Services Research; D008329:Managed Care Programs / Q000592:standards*; D008484:Medicaid / Q000592:standards* / Q000639:trends; D006278:Medicare / Q000592:standards* / Q000639:trends; D011366:Professional Review Organizations / Q000458:organization & administration*; D011785:Quality Assurance, Health Care / Q000458:organization & administration / Q000639:trends*; D012941:Social Responsibility; D014481:United States