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Two steps to enhance managed care quality

P L Grimaldi1

  • 1Birch & Davis Health Management Corp., Silver Springs, Md., USA.

Nursing Management
|November 10, 1998
PubMed
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Managed care organizations (MCOs) face increased scrutiny regarding quality. New Medicare applications and National Committee for Quality Assurance (NCQA) accreditation initiatives reflect this growing national concern.

Area of Science:

  • Healthcare Quality Management
  • Health Services Research
  • Managed Care Policy

Background:

  • Public and governmental concern regarding the quality of managed care organizations (MCOs) is escalating.
  • This concern is reflected in recent policy and accreditation developments within the healthcare sector.

Purpose of the Study:

  • To highlight key developments indicating national concern over managed care organization quality.
  • To inform stakeholders about emerging standards and requirements for MCOs.

Main Methods:

  • Analysis of recent regulatory and accreditation initiatives impacting MCOs.
  • Identification of specific developments signaling increased quality oversight.

Main Results:

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  • Introduction of a new application form for MCOs seeking Medicare risk contractor status.
  • Planned launch of performance-based accreditation for MCOs by the National Committee for Quality Assurance (NCQA) in mid-1999.

    • Conclusions:

    • These developments underscore a significant national focus on improving and ensuring the quality of managed care.
    • MCOs must adapt to new quality assessment and accreditation standards.