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Related Experiment Videos

Are managed care plans organizing for quality?

D P Scanlon1, E Rolph, C Darby

  • 1Pennsylvania State University, USA.

Medical Care Research and Review : MCRR
|December 6, 2000
PubMed
Summary

Managed care organizations (MCOs) are reorganizing to improve healthcare quality, driven by external pressures. While management structures are adapting, building technical capacity for quality improvement (QI) remains a slower, tentative process.

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Area of Science:

  • Health Services Research
  • Healthcare Management
  • Quality Improvement Science

Background:

  • Managed care organizations (MCOs) face increasing pressure to demonstrate and improve the quality of care and services.
  • Understanding the internal dynamics and capacity-building efforts within MCOs is crucial for effective healthcare delivery.

Purpose of the Study:

  • To examine the extent to which MCOs are reorganizing to assume responsibility for care quality.
  • To identify factors driving MCOs' focus on quality improvement (QI).
  • To assess how MCOs are developing the capacity for QI.

Main Methods:

  • Qualitative study involving executive interviews with medical directors, QI directors, and CEOs across 24 health plans.
  • Response rate of 58.3% achieved.

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  • Inquiries focused on QI drivers, obstacles, organizational structure, and technical capacities for data and performance measurement.

    • Main Results:

    • MCOs are actively reorganizing management structures in response to external pressures to engage in QI.
    • The development of technical capacities for data collection, management, and performance measurement is progressing more slowly and tentatively.
    • Perceived drivers and obstacles significantly influence the development of effective QI programs within MCOs.

    Conclusions:

    • MCOs are demonstrating a growing commitment to quality improvement, primarily through structural reorganization.
    • Building robust technical infrastructure for QI lags behind structural changes, indicating a potential gap in fully realizing quality improvement goals.
    • External pressures are a significant catalyst for MCOs' engagement in quality improvement initiatives.