Give one (1) way in which the NCQA uses HEDIS measures for accreditation of Managed Care...
Give one (1) way in which the NCQA uses HEDIS measures for accreditation of Managed Care Health Plans as well as integrated health care delivery systems (Accountable Care Organizations) performing managed care functions.
Homework Answers
HEDIS data aid to calculate national performance statistics and benchmarks, and set standards for measures in NCQA Accreditation.With plan permission, commercial data are also included in Quality Compass. Health plans, purchasers, consultants and the media use Quality Compass data for comparative health plan performance analyses.
The Healthcare Effectiveness Data and Information Set (HEDIS) is one of health care’s most widely used performance improvement tools. 190 million people are enrolled in plans that report HEDIS results.
NCQA collects HEDIS survey results directly from health plans and PPOs through the Healthcare Organization Questionnaire (HOQ), and collects non-survey data though the Interactive Data Submission System (IDSS).
Hedis measures -
Health Plan Descriptive Information.
Measures Collected Using Electronic Clinical Data Systems
Effectiveness of Care.
Access/Availability of Care.
Experience of Care.
Utilization and Risk Adjusted
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Give one (1) way in which the NCQA uses HEDIS measures for
accreditation of Managed Care...
As managed care has evolved, new delivery systems have been established. One such delivery system...
As managed care has evolved, new delivery systems have been established. One such delivery system is the Accountable Care Organization (ACO) . Describe the ACO its beginnings, overall objectives, its structure and key features. Managed care companies are partnering with providers to establish ACO’s. Discuss the positive or negative impact the ACO will have on reducing health care costs while producing quality outcomes.
Which of the following statements about accountable care organizations (ACOs) is most correct? O ACOs must...
Which of the following statements about accountable care organizations (ACOs) is most correct? O ACOs must include the following set of providers: hospital, physician group, urgent care center, and home health agency. O ACOs need only a minimum of managerial systems in place because the payer (primarily Medicare) assumes most of the managerial functions. GACOs are radically different from other attempts to improve the delivery of health services. O ACOs can distribute bonuses when targets are met and impose penalties...
DISCUSSION QUESTION 5-1 MH684 Managed Health Care Lesson 5: Managed Care Operations Upon completion of the...
DISCUSSION QUESTION 5-1 MH684 Managed Health Care Lesson 5: Managed Care Operations Upon completion of the Required Readings, write a thorough, well-planned narrative answer to the following discussion question. Rely on your Required Readings and the Lecture and Research Update for specific information to answer the discussion question, but turn to your original thoughts when asked to apply, evaluate, analyze, or synthesize the information. Your Discussion Question response should be both grammatically and mechanically correct, and formatted in the same fashion...
Lesson 2: Managed Care Delivery Systems Upon completion of the Required Readings, write a thorough, well-planned...
Lesson 2: Managed Care Delivery Systems Upon completion of the Required Readings, write a thorough, well-planned narrative answer to the following discussion question. Rely on your Required Readings and the Lecture and Research Update for specific information to answer the discussion question, but turn to your original thoughts when asked to apply, evaluate, analyze, or synthesize the information. Your Discussion Question response should be both grammatically and mechanically correct, and formatted in the same fashion as the question itself. If there...
Report cards are one means by which MCOs are measured against the other. Health information systems...
Report cards are one means by which MCOs are measured against the other. Health information systems help with reporting. The links for report cards listed below are a few examples of what is reported to the public by accreditation agencies, by employer groups, by regulators and more. In examining the report cards, note that there are structure, process and outcome measures. Consider the report cards listed below and the value of measuring outcomes and processes. Given the different rates of...
Lesson 2: Managed Care Delivery Systems Upon completion of the Required Readings, write a thorough, well-planned...
Lesson 2: Managed Care Delivery Systems Upon completion of the Required Readings, write a thorough, well-planned narrative answer to the following discussion question. Rely on your Required Readings and the Lecture and Research Update for specific information to answer the discussion question, but turn to your original thoughts when asked to apply, evaluate, analyze, or synthesize the information. Your Discussion Question response should be both grammatically and mechanically correct, and formatted in the same fashion as the question itself. If there...
1. A Third-party payer is an agent of the patient that contracts with the provider to...
1. A Third-party payer is an agent of the patient that contracts with the provider to pay all or a portion of the bill of the patient and can be a: a. Government organization b. Any of these c. Private Organization 2.A concept which emphasizes coordination of care among various healthcare providers is: Select one: a. Managed Care Organization (MCO) b. Physician-Hospital Organization (PHO) c. Accountable Care Organization (ACO) d. Integrated Delivery Organization (IDO) Question text 3.A graphical method that...
30. A client admitted to a health care facility uses a walker for support. What is...
30. A client admitted to a health care facility uses a walker for support. What is the nurse's responsibility with regard to the walker when admitting the client to the nursing unit? A) Provide the client with another walker during their stay at the facility B) Mark the clients walker with a large, easily readable label. C) Keep the walker in a locker until the client is discharged. D) Ask relatives to bring the walker only at the time of...
(5pts) 6) Which type of HMO offers patients the least selection in referrals to specialists? (5pts)...
(5pts) 6) Which type of HMO offers patients the least selection in referrals to specialists? (5pts) 7) What are the three reasons Medicaid enrolls members in managed care plans? 8) Medicare Special Needs Plan fill the gaps in what Medicare does not pay by serving as a (5pts) (Sots) 9) Functional integration is the integration of the functions that support the delivery of direct patient care. Examples include financial services, Information systems and Sots) 10) Horizontal consolidation is when a...
1. Tax-exempt employer-purchased health insurance: decreases the patient's incentive to be concerned about the cost and...
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...
Which of the following statements about accountable care organizations (ACOs) is most correct? O ACOs must include the following set of providers: hospital, physician group, urgent care center, and home health agency. O ACOs need only a minimum of managerial systems in place because the payer (primarily Medicare) assumes most of the managerial functions. GACOs are radically different from other attempts to improve the delivery of health services. O ACOs can distribute bonuses when targets are met and impose penalties...
30. A client admitted to a health care facility uses a walker for support. What is the nurse's responsibility with regard to the walker when admitting the client to the nursing unit? A) Provide the client with another walker during their stay at the facility B) Mark the clients walker with a large, easily readable label. C) Keep the walker in a locker until the client is discharged. D) Ask relatives to bring the walker only at the time of...
(5pts) 6) Which type of HMO offers patients the least selection in referrals to specialists? (5pts) 7) What are the three reasons Medicaid enrolls members in managed care plans? 8) Medicare Special Needs Plan fill the gaps in what Medicare does not pay by serving as a (5pts) (Sots) 9) Functional integration is the integration of the functions that support the delivery of direct patient care. Examples include financial services, Information systems and Sots) 10) Horizontal consolidation is when a...
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