National Health Insurance Plans

Paper Summary:

The paper discusses the vast differences between the cost of health services in the United States and the delivery of health services in the United States. The paper examines how measuring the success of medical care is one of the greatest challenges that regulators and providers face in assessing the current level of care and the success of new plans that are designed to alleviate the stresses being placed on the current system. The paper analyzes the groups attempting to find an accurate measurement tool for assessing the quality of care for managed care plans.

Outline:
Part 1: Expectations of Quality
Current State of Quality Measurement
Stakeholder Expectations
Part II: A Case Study
Part III: Source Evaluation

From the Paper:

"Currently most performance measures are developed internally by the organization (Isham). This creates a situation on a national level where research and development capabilities cannot be used on a national level. Private standardization is better than no standardization, but this is not likely to lead to the changes needed on a national level to help control the crisis."

Sample of Sources Used:

• Empire Blue Cross/ Blue Shield. HEDIS/QARR Results. 2004/2005. http://www.empireblue.com/wps/portal/ehpprovider?content_path=provider/noappl ication/f2/s1/t0/pw_ad067446.htm&label=HEDIS/QARR%20Results Accessed June 2006.
• Institute of Medicine. Committee on Redesigning Health Insurance Performance Measures, Payment, and Performance Improvement Programs. Performance Measurement: Accelerating Improvement. Washington, DC: The National Academies Press; 2006.Available at: http://darwin.nap.edu/books/0309100070/html/. Accessed June 2006.
• Isham, G. Toward National Healthcare Performance Standards. American Journal of Managed Care. http://www.ajmc.com/Article.cfm?Menu=1&ID=3146 Accessed June 30, 2006.
• Sullivan, J. Hudson Health Plan. Health Source. 2005.http://www.ahcahp.org/bppo/qarr%20improvements.ppt#257,1,Slide 1. Accessed June 2006.
• The Health Plan Employer Data and Information Set (HEDIS(r)).Public Comment for the Development of PPO HEDIS(r) Technical Specifications. June 14 - July 14, 2006 http://www.ncqa.org/programs/hedis/. Accessed June 30, 2006.

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