Toward a 21st century quality-measurement system for managed-care organizations.
Armstead, Rodney C
Date of Pub
Elstein, Paul; Gorman, John K
As the Nation's largest managed-care purchaser, the Health Care Financing Administration (HCFA) is working to develop a uniform
data and performance-measurement system for all enrollees in managed-care plans. This effort will ultimately hold managed-care
plans accountable for continuous improvement in the quality of care they provide and will provide information to consumers
and purchasers to make responsible managed-care choices. The effort entails overhauling peer review organization (PRO) conduct
of health maintenance organization (HMO) quality review, pilot testing a new HMO performance-measurement system, establishing
criteria for Medicaid HMO quality-assurance (QA) programs, adapting employers' HMO performance reporting systems to the needs
of Medicare and Medicaid, and participation in a new alliance between public and private sector managed-care purchasers to
promote quality improvement and accountability for health plans.
Capitation Fee : Health Services Research : Managed Care Programs/standards : Medicaid/standards/trends : Medicare/standards/trends
: Professional Review Organizations/organization & administration : Quality Assurance, Health Care/organization & administration/trends
: Social Responsibility : United States : United States Health Care Financing Administration