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Essay on Managed Care Organizations
Preparing for Managed Care, Accreditation, and Competition. In the current era of managed care and intensifying competition among provider groups, PCPs and health plans are struggling to remain financially viable, and are being held accountable for patient outcomes in new ways. The ability to compete may depend on the group's capacity to demonstrate its superior quality of care and patient outcomes. Increasingly, patient surveys and other assessment tools are utilized to evaluate the quality of care.
These tools have become more important as outside organizations are performing patient satisfaction surveys and monitoring patients' clinical and functional outcomes. Information gleaned from assessment tools is now being used by accrediting organizations, advocacy groups, and those contracting for health care services to measure the quality of care. The availability of such data exerts new pressure on providers to strive for satisfied patients and better outcomes, and to do whatever it takes to accomplish those goals. (National Committee for Quality Assurance, 1997)
Nationally, governmental and quasi-governmental organizations have begun to recommend or mandate the use of specific measures to assess the quality of health care. In the late 1990s, these organizations include the National Committee on Quality Assurance (NCQA), which accredits managed care organizations and publishes health care accountability standards; the Foundation for Accountability (FACCT), which develops accountability measures to guide health care decision making; the Health Care Financing Administration (HCFA), which administers the federal Medicare......
