Quality Assurance in Managed Care
Consider challenges existing for insured consumers. Your goal is to identify indicators of quality from consumer and administrative bodies.
You are the hospital administrator and members of the board are calling upon you to explain what is going on in your facility with reference to managed care. Some members of the board are not pleased with the budget, patient satisfaction, and rumors that quality care is not being given due to negative surveys they have read. You need to show the board answers.
Write and Present answers/points for the following questions. Number your response 1-6.
1. Why patients are having difficulty accessing care (issues of access and referral to be included).
2. What your facility is doing to assure that quality care is being given.
3. In at least two slides, show how managed care is affecting your budget for the hospital.
4. In at least two slides, show how quality is determined from a patient perspective and administrative body.
5. What is your facility doing to bring these patient surveys into a better light?
6. Present slides that show at least four to five recommendations for improvement of the managed care system.ND ACCESS TO QUALITY CARE
Before starting this assignment, please view these short videos:
6 Dimensions of Healthcare Quality
Thompson, B. & Robbins, A. (n.d.) Understanding managed care. Washington State DSHS. Retrieved from: https://www.dshs.wa.gov/sites/default/files/BHSIA/dbh/Integration/Webinar%20Understanding%20Managed%20Care.pdf
Note: Answer all questions. Support your assignment with peer-reviewed articles, with at least 3-4 references.
Part B (4 pages)
The purpose of the Session Long Project is to evaluate quality for managed care organizations and hospitals. The following resource should help you when accessing quality report cards.
Health and Human Services Website:
Please explain how Health and Human Services formulates its quality ratings for hospitals. Consider at least one advantage and one disadvantage of this published information.
Part C (2 pages)
There are many kinds of managed care plans—an alphabet soup—for example, with PSOs, PPOs, and HMOs the most prominent. Managed care plans use a number of techniques. Some of them are directed at physician behavior. Others are directed at subscribers to the plan.
1. What do you believe to be the major obstacle to access in managed care? Be sure to provide support for your position.
2. Discuss some of the ethical concerns and what you would do about the ones you discussed