Question

Discuss the managed care accreditation process. Do you feel that accreditation is important for managed care organizations? Why or why not?

Answer 1

Managed care plan are health insurance . It refers to wide range of health care organizational strategies aimed at controlling cost, improving access and assuring high level quality of care provided to those covered under medical insurance. It organize health care providers to achieve dual goals of controlling health care costs and managing quality of care.They have contracts with health care providers and medical facilities to provide care at lower cost.

Managed care have arrangements with certain physicians, hospitals and health care providers to serve patients who are plan members at a contracted reduced rate.The main types are HMO : Health Maintenance Organizations, PPO : Preferred Provider Organization, POS : Point of Service Plan EPO : Exclusive Provider Organization.

The purpose of managed care is to reduce cost if health care services by stimulating competition and streamlining administration.

Accreditation is the certification of competency, authority or credibility. It is the act of granting credit or recognition that maintain suitable standards.

Accreditation of managed care is considered as a process by which Council will review a managed care organization operation to ensure that it is conducting business in a manner consistent with defined standards. The accreditation process consists of :

- review of application, contract organization structure, policies and procedures

- onsite visit to applicant organizations to determine that it has required skills, infrastructure and systems capable of providing managed care services

- a reporting system that enables council to monitor performance of organization and overall impact of managed care on medical industry.

Accreditation is important to managed care organization because it is required in order for their organization to receive positive response and funding from Medicare programs. It also solidifies organization position, help organizations to focus on patient safety, professional recognition. When an organization meet national standard level ,then quality and safety is guaranteed, and patients treated at the facility can be assured they are receiving best care.Accreditation ensures high quality outcomes for patients.