Related Experiment Videos
Quality oversight for Medicaid managed care plans: impact on providers
Judith Cukor1, Gerry Fairbrother, Anthony Tassi
1Department of Epidemiology, Albert Einstein College of Medicine/Montefiore Medical Center, USA.
Abstract:
The purpose of this study was to describe managed care organization (MCO)-provider interactions around quality monitoring in Medicaid managed care. Heads of ambulatory pediatrics in institutions and private providers in offices in New York City (NYC) responded to questions regarding several forms of MCO-provider communications around quality. It appears that the current quality monitoring review process undertaken by managed care plans in provider sites in NYC is duplicative and overlapping. Feedback from the quality reviews is not being received by the providers who are giving care and incentives/disincentives are not felt. These constitute severe limitations to the current system of quality oversight.
Related Concept Videos
Methods of Documentation VI: Case Management Model
For example, a patient with a chronic illness...
Issues And Trends In Healthcare Delivery System
Cost Containment
Payment for healthcare services has historically promoted adoption of costly and often unnecessary or inefficient...
Health Information Technology and Healthcare Information System
Health Information Technology, commonly called HIT, integrates advanced information systems and technology in healthcare settings. Its primary functions include:
Standards of Care I
Introduction to Documentation and Reporting
Nursing documentation records essential information and details regarding a patient's care and treatment in written or electronic form. It is a critical aspect of nursing practice that involves documenting assessments, interventions, outcomes, and other relevant details about a patient's health status.
Documentation maps the patient's health journey by creating a comprehensive and precise...
Purpose of Health Records I
Here's a breakdown of how health records serve these purposes: