What is influencing performance improvement in managed care?

Area of Science:

• Healthcare Management
• Quality Improvement
• Health Services Research

Background:

• Managed care organizations face increasing scrutiny regarding quality of care.
• Consumers and healthcare providers share concerns about quality within managed care.
• Performance improvement initiatives often target preventive health, provider access, and service availability.

Purpose of the Study:

• To identify the primary drivers influencing quality programs in managed care.
• To provide an overview of external reporting requirements impacting managed care quality.
• To understand the influence of external stakeholders on managed care quality initiatives.

Main Methods:

• Literature review of external reporting requirements.
• Analysis of quality program influences in managed care.
• Overview of regulatory and accrediting body mandates.

Main Results:

• Purchasers of health care impose external reporting requirements.
• Accrediting bodies issue mandates that influence quality programs.
• Regulatory agencies establish standards affecting managed care quality initiatives.

Conclusions:

• External reporting requirements are a significant driving force for quality programs in managed care.
• Stakeholder demands shape the focus of quality improvement activities.
• Compliance with external mandates is crucial for managed care organizations.