Managed Care And Quality Improvement Essay

1248 words - 5 pages

Managed care is often seen primarily as a cost cutting initiative that is concerned with managing cost and cost only in the healthcare field. For this and a few more reasons managed care organizations face severe judging on the quality of care that they provide. When analyzed correctly, trends prove that managed care has in fact been very significant in determining and improving the quality of care. In this paper, elements such as the state and federal oversights over MCOs, voluntary accreditations, standardized performance indicators and examples of successful quality programs developed by MCOs will be used to prove this statement. Though in the eyes of many managed care and quality do not go together, the research information provided in this paper will show that MCOs are placing more emphasis on measuring and improving the quality of healthcare and therefore should be considered as an important force in such.

Most of the managed care industry is governed and handled by for-profit organizations, which leads many to believe it focuses more on managing costs and obtaining profit than in the quality of care provided to individuals. To add to this, MCOs legal policies place them in the predicament of having to put stockholders before consumers and/or payers. Furthermore, recent studies suggest that ever since the shift of financial risk to providers through the process of capitation, such have become even more financially free to not provide all the necessary care needed. However, the managed care industry has counterattacked these statements by demonstrating throughout these years that it is in fact not only about managing costs, but also about managing quality and improving it as well. As time passes it has been noted that MCOs are putting more of a proactive focus on their quality assurance standards and placing them at an ever time high. More methods are being created and taken place to ensure, inspect, repair and correct performance where it is needed to do so. MCOs have developed a new status quo of improving and performing better every year with tools such as the “Quality Drivers of Care” (Miller, 2004). One of these tools, perhaps the most important one, is the voluntary accreditation of MCOs by organizations such as the National Committee on Quality Assurance, the Joint Commission on Accreditation of Healthcare Organizations, and the Utilization Review Accreditation Commission, among others. While MCOs are not required to do so they choose to, to show the industry that they are being assessed in the quality and service they provide and that improvements are in fact being made. They are also drivers in effectiveness and quality assurance as MCOs now find themselves competing amongst each other not only on costs but also on their effectiveness.

Some argue that managed care does not improve the quality of care because according to several studies, performance indicators for such, rank very low in populous states and high in less...

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