Quality verse Accountablity

This Folder concerns quality assurance and accountability in manged care. I have included several different aspects on this topic. Included are organizations that evaluate and monitor manged care plans, a governmental agency, a private HMO organization, and a state HMO trade organization. As the issue of quality care, performance standards, and report cards have become a buzzword in the managed care industry. The interested party will find this folder a good introductory primer on accountability in managed care systems.

Documents

IMPAQ Series
IMPAQ(Improved Margin Performance, Appropriateness,and Quality) products are designed to measure and compare clinical and financial performances of hospitals and physicians. Impaq serves four functions: managed care contracting, cost reduction, pricing analysis, and quality improvement. Among the IMPAQ products are: hospital and doctor efficiency and effectiveness data, clinical pathways analysis, Impaq softwear for the PC, and clinical quality benchmarking analysis. Thios web page gives a good product listing of quality analysis in evaluating health care services as an alternative to NCQA.
Mass HMO Assoc. Quality of care
This page explains how quality of care in this state's HMO'S are mantained and evaluated. It explains how doctor's are chosen into the plan, internal and external quality controls, and patient satisfaction surveys. This page gives this topic the perspective from the HMO's point of view.
NCQA-Hedis information
This web page describes the Health Plan Employer Data and Information Set(HEDIS.) Hedis attempts to define as well as standardize the measurement process. Hedis allows the purchasers to follow a yearly trend to compare health plans. The five areas include: quality of care, member access, membership and utilization, finance, and descriptive information. As Hedis has become the benchmark in performance, this page is very helpful for accountability purposes.
Quality of Care -- Medicare PRO Program
This page describes the Medicare Peer Review Organizations that exist in each state. It also describes its Health Care Quality Improvement Program (HCQIP.) It is based on Medicare's quality assurance programs. It descibes how the PRO'S work with the local health care community to identify sound parameters of practice to measure the quality of care. This page elaborates HCQIP'S objectives as well as the state's PRO'S regulations. This site also includes access to each state's PRO'S.
USHC- Quality Assurance
This page explains the NCQA accreditation process that its seven health plans have received. It explains the NCQA criteria and its own Hedis guideline quality assurance systems. USHC became the first HMO to issue a quality report card based on NCQA'S criteria. See related NCQAS site and Hedis web page in this folder.

Sites

HCIA home
HCIA is leading health care information company that develops and markets clinical and financial decision support systems for the health cae industry. The company's databases and products are used to evaluate clinical performance and outcomes. This site is helpful in that this company provides much information and services for accountability. This home page provides access to HCIA'S databases and services. It is easy to navigate through this site . 3 Star Site Rating
Health Care Financing Administration (Medicare & Medicaid)
The Health Care Financing Administration is a tremendous site for describing the agency that administers Medicare and Medicaid. It summarizes the activiites of this agency as well as describes its mission to provide equal access to health care. This site also provides access to the agency's publications, research, statistics, and regulations. THis site is organized extremely well making it simple to explore the vast resources of this agency. 5 Star Site Rating
Mass. Assoc. of HMO'S
This web site is the home page of the Mass. Assoc. of HMO's.(MAHMO) This trade organization represents 17 HMO'S in the state. The goal of this organization is to represent the interests of its members. Functions include legislative advocacy, research, policy analysis, and communications. I included this site because I thought it would be interesting to get the perspective of a state's HMO'S members themselves. This site is weel organized and easy to navigate through. 4 Star Site Rating
NCQA
NCQA is a not-for-profit organization dedicated to reporting on the quality of managed care plans. The goal is to provide information to consumers of managed care plans to enable them to differentiate the different plans based on quality. They judge on two standards: accredidation and performance reviews. NCQA is the hallmark organization for evaluating quality in plans so it is essential to include it as a site on this topic. This site contains an overview of the organization as well as an evaluation list of the different manged care plans. 5 STAR SITE RATING
Welcome to U.S. Healthcare's Home Page
This site describes information and a index of a leading HMO organization in the Northeast--US HEALTHCARE. Information includes health information, seeking a plan doctor, the various health plans offered, and member services. This site represents an industry leader and their web site that is very appealing as well as organized efficiently. 4 Star Site Rating.

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