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Evaluating health plan quality 1: a conceptual model
Douglas R Wholey1, Jon B Christianson, Michael Finch
1Division of Health Services Research and Policy, University of Minnesota, Minneapolis, Minn 55455, USA. whole001@umn.edu
The American Journal of Managed Care
|June 26, 2003
Summary
Physicians can assess health plan quality by evaluating management practices that influence care delivery. This study developed a conceptual model to guide physicians in measuring health plan quality effectively.
Area of Science:
- Healthcare Management
- Quality Improvement
- Physician Perspectives
Background:
- Measuring health plan quality is complex and often lacks a physician-centered framework.
- Existing quality measures may not fully capture the impact of health plan management on care delivery.
Purpose of the Study:
- To establish a theoretical basis for assessing health plan quality from a physician's viewpoint.
- To differentiate health plan quality from the quality of medical care itself.
Main Methods:
- Conducted a comprehensive literature review.
- Developed a theoretical framework and conceptual model for health plan quality measurement.
Main Results:
- A conceptual model was created, organizing health plan management practices.
- This model provides a structure for evaluating health plan quality through a physician's lens.
Conclusions:
- Health plan quality is a distinct construct from the quality of care provided.
- Physicians offer valuable, real-time insights into health plan quality aspects.