Chapter 5: Managed Care Activities: Quality Assurance Flashcards
What does a quality assurance program includes?
Activities that assess the quality of care provided by managed care plans.
What does types of quality reviews performed include?
Government oversight, patient satisfaction surveys, data collected from grievance proceedings.
Reviews conducted by Independent Organizations such as?
The National Committee for Quality Assurance (NCQA)
The NCQA began in 1979 as a managed care industry alternative to?
Government oversight.
How does the NCQA accredits health insurance plans, physician groups and other medical businesses through?
An evaluation system called the Healthcare Effectiveness Data and Information Set (HEDIS)
What is used to track how well the health plan’s providers comply with the recommended standards of care and cost-effectiveness?
HEDIS medical record reviews.
Why is HEDIS data is released to the public and widely used by employers?
To compare different health plans for their employees.
