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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
This summary is machine-generated.

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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.

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.

Related Experiment Videos

  • 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.