Patient Ratings of the Overall Quality of Care in 2 Managed Care Organizations Were Not Associated with Measures of the Technical Quality of Care

2006 ◽  
Vol 144 (9) ◽  
pp. I-26 ◽  
Keyword(s):  
Quality Of Care ◽  
Managed Care ◽  
Technical Quality ◽  
Managed Care Organizations

The association between quality improvement activities performed by managed care organizations and quality of care

2004 ◽  
Vol 117 (5) ◽  
pp. 297-304 ◽  
Author(s):  
Jeff Borenstein ◽  
Enkhe Badamgarav ◽  
James M. Henning ◽  
Anacleto D. Gano ◽  
Scott R. Weingarten
Keyword(s):  
Quality Improvement ◽  
Quality Of Care ◽  
Managed Care ◽  
Managed Care Organizations

Assuring Quality of Care for Children With Special Needs in Managed Care Organizations: Roles for Pediatricians

PEDIATRICS ◽  
1996 ◽  
Vol 98 (2) ◽  
pp. 178-185 ◽  
Author(s):  
Henry T. Ireys ◽  
Holly A. Grason ◽  
Bernard Guyer
Keyword(s):  
Quality Of Care ◽  
Managed Care ◽  
Service Delivery ◽  
Health Outcomes ◽  
Care Needs ◽  
Developmental Issues ◽  
Managed Care Programs ◽  
The Individual ◽  
Managed Care Organizations

Increasing numbers of children with special health care needs are enrolling in managed care programs. Although managed care may improve service coordination and use of primary care, it may also threaten health outcomes for these children by potentially decreasing access to the range of needed services, eroding progress in developing community-based service systems, and failing to assure quality of care. To date, few frameworks have been proposed to assess quality of care for this population of children in managed care organizations. In this article, we adapt the Institute of Medicine's definition of quality and identify six key components: content of service delivery systems, the nature of desired health outcomes, risks associated with service delivery, constraints of care, interpersonal dimensions, and attention to developmental issues. These components can be assessed at three levels: the individual, the health plan, and the community. Pediatricians and other child health professionals have critical roles to play in assuring that policies and practices within managed care organizations promote a high quality of care for this vulnerable population of children.

scholarly journals Does service integration improve technical quality of care in low-resource settings? An evaluation of a model integrating HIV care into family planning services in Kenya

2017 ◽  
Vol 32 (suppl_4) ◽  
pp. iv91-iv101 ◽  
Author(s):  
Richard Mutemwa ◽  
Susannah H Mayhew ◽  
Charlotte E Warren ◽  
Timothy Abuya ◽  
Charity Ndwiga ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Family Planning ◽  
Service Integration ◽  
Hiv Care ◽  
Technical Quality ◽  
Family Planning Services ◽  
Low Resource Settings ◽  
Low Resource

Managed Care Organizations' Assessment of Reimbursement for New Technology, Procedures, and Drugs

1999 ◽  
Vol 123 (8) ◽  
pp. 677-679
Author(s):  
Harold Zarkowsky
Keyword(s):  
Managed Care ◽  
New Technology ◽  
Third Party ◽  
Medical Community ◽  
Extensive Literature ◽  
Behavioral Measures ◽  
Randomized Controlled Studies ◽  
Marginal Improvement ◽  
Managed Care Organizations

Abstract Managed care organizations must establish formal processes for the evaluation of new technology, procedures, and drugs to enhance the quality of health care delivered and to support coverage and utilization decision making. Evidence-based research and the results of controlled clinical trials are the preferred sources of outcomes data to support the safety and effectiveness of the technology, procedure, or drug under review. In addition to extensive literature review, the opinion of experts in the field and acceptance by the medical community are considered. Assessments of new technology and drugs are available for purchase from several vendors, and managed care organizations can adopt or modify such evaluations to develop medical coverage policies. The research community can assist third-party payers by conducting studies on practices that might lead to substantial, rather than marginal, improvement in health, pay particular attention to study design when randomized controlled studies are not possible, and include functional and behavioral measures in analysis of outcomes.

scholarly journals Assessing the Quality of Nursing Homes in Managed Care Organizations: Integrating LTSS for Dually Eligible Beneficiaries

2018 ◽  
Vol 55 ◽  
pp. 004695801880009
Author(s):  
Carrie Graham ◽  
Leslie Ross ◽  
Edward Bozell Bueno ◽  
Charlene Harrington
Keyword(s):  
Managed Care ◽  
Nursing Homes ◽  
Quality Criteria ◽  
Limited Attention ◽  
Home Networks ◽  
Services And Supports ◽  
Managed Care Organizations ◽  
Quality Of Nursing

Little is known about the quality of nursing homes in managed care organizations (MCOs) networks. This study (1) described decision-making criteria for selecting nursing home networks and (2) compared selected quality indicators of network and nonnetwork nursing homes. The sample was 17 MCOs participating in a California demonstration that provided integrated long-term services and supports to dually eligible enrollees in 2017. The findings showed that the MCOs established a broad network of nursing homes, with only limited attention to using quality criteria. Network nursing homes (602) scored significantly lower on 6 selected quality measures than nonnetwork (117) nursing homes. Low registered nurse and total nurse staffing were strong predictors of network nursing homes controlling for facility characteristics. Managed care organizations should consider greater transparency about the quality of their nursing homes and use specific quality criteria to improve the quality of their networks.

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