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What are purchasers looking for in managed care quality?

E H Lipson1

  • 1Ernst & Young, San Francisco, California.

Topics in Health Care Financing
|January 1, 1993
PubMed
Summary

Healthcare purchasers are increasingly prioritizing managed care quality due to competition and cost concerns. Providers must demonstrate value and accountability through improved service and clinical care.

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Area of Science:

  • Healthcare Management
  • Quality Improvement
  • Health Services Research

Background:

  • Managed care organizations (MCOs) face increasing pressure from purchasers focused on value and quality.
  • Concerns regarding undercare, legal liability, and the economics of healthcare quality are driving this shift.
  • Purchasers evaluate both patient experience and clinical outcomes in assessing healthcare quality.

Purpose of the Study:

  • To examine the evolving focus on quality within managed care arrangements.
  • To understand the drivers behind purchasers' emphasis on healthcare value.
  • To identify tools and strategies for enhancing provider accountability for quality.

Main Methods:

  • Analysis of trends in healthcare purchasing and managed care.
  • Review of factors influencing provider focus on quality metrics.
  • Examination of the role of data banks, practice standards, and accreditation.

Main Results:

  • Purchasers are actively assessing multiple dimensions of quality, including patient experience and clinical effectiveness.
  • The growth of managed care has intensified the demand for demonstrable quality and value.
  • Emerging resources like national data banks support provider accountability.

Conclusions:

  • Managed care providers must adapt to purchaser demands for comprehensive quality management.
  • A multi-faceted approach to quality, encompassing patient experience and clinical outcomes, is essential.
  • Leveraging available tools can strengthen provider accountability and improve healthcare value.

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