The Health Plan Employer and Data Information Set (HEDIS) is often used to evaluate care quality offered by managed health care plans. Select one: a. true b. false
TRUE
HEDIS is a set of standardized performance measures designed to provide purchasers and consumers with the information they need to reliably compare healthcare organizations’ performance. HEDIS contains measures that cover prevention, acute and chronic care including mental health and chemical dependency across a full range of care settings like physician office, clinics and hospital outpatient care, inpatient acute and non-acute care, and behavioral health. HEDIS operates under following 6 domains:
The Health Plan Employer and Data Information Set (HEDIS) is often used to evaluate care quality...
SIX SIGMA methods are often used to assess quality of care within hospitals and medical treatment centers? Select one: a. true b. false
Discuss the type of health plans that employer premium costs for health care coverage are often lowest.
Real-World Case Value-Based Purchasing: Performance measures across the states’ Medicaid plans vary widely (Kuhmerker and Hartman 2007a, 13). Often these performance measures are the Health Plan Employer Data and Information Set (HEDIS®) measures or a similar set (Kuhmerker and Hartman 2007a, 8). Included in the HEDIS are measures related to immunizations, screenings, appropriate prescriptions, and preventive and follow-up care (NCQA 2007, 1-1–1-11). Meeting or exceeding the targets or thresholds in the performance measures is thought to represent quality and results...
1. Tax-exempt employer-purchased health insurance: decreases the patient's incentive to be concerned about the cost and use of services. is being eliminated by the Affordable Care Act. provides physicians an incentive to be more concerned about their patients' use of services. is also available to those who are self-employed. 2. The individual health insurance market: covers most people who have health insurance. covers a small percentage of people with health insurance. is used by employers for their employees. has been...
True or False? When quality data is shown to consumers in health care, demand can become elastic. True or False? The bronze, silver, and platinum health insurance plans on state and federal health exchanges may be considered an example of price lining. True or False? When considering the positioning value of price, whether it is active or passive pertains to how visible price is in promoting the product or service.
Many consumer and health care advocacy initiatives are converging toward a mandate to provide public access to many types of information about managed care organization (MCO) performance, costs, and quality. In fact, employers in the many parts of the country who are the major purchasers of health insurance are now requiring MCOs to make “health plan performance data” available to subscribers to facilitate their choice of plans. Discuss and provide the rationale for your opinion on providing data in areas...
Answer the following questions Managed Care was created in an attempt to control the cost, quality and access to health care. Some would argue this has been accomplished, while others would disagree. Complete the below in an attempt to support that this triple aim of health care is underway. Cost: Identify on method/structure technique that Managed Care plans use in attempt to control cost Identify one strength/success and one weakness/failure of that method/structure/technique Propose an original idea that may be...
Managed care is characterized by a strategy of organizing healthcare providers with actual health care costs while managing the quality of care received by patients. As a result of the way managed care is set, issues are inevitable with this system. Some of the main problems associated with managed care affecting patients include lack of access to care, loss of member privacy, and reduced quality of care (Frank, Glazer & McGuire, 2017). There are many constraints that serve as barriers...
Quality of care is an important concept for any health care organization. As defined by your text, quality care is: Select one: a. An abstract organizational concept that is difficult to measure or observe in reality b. A benign formality in the health care industry that is mainly used to maintain a positive image in the public's eye c. An annoying federal mandate that health care professionals and administrators must observe d. A measure or indicator of the level of...
Evaluate these health care models: Managed Care - Competition Consumerism What model, or hybrid model, would you recommend to maximize quality of care while controlling health care costs in the future? What would be components of a hybrid model? How could these models be used in ongoing development of the Patient Protection and Affordable Care Act?