Can you give me constructive criticism on my paper? Introduction…

Question Answered step-by-step Can you give me constructive criticism on my paper? Introduction… Can you give me constructive criticism on my paper? IntroductionThe issues around the quality of medical care have became a subject of increasing complexity confusion and public interest. As managed care has rapidly emerged as the the preferred form of health insurance in the United states Insurers and physicians under managed care also ask to know what type of quality of care their getting for their moneys worth. Effective improvement in the quality of care must be implemented to control the magnitude and scope of the quality problems that prevent Americans from receiving the full potential benefits of their medical care . The initiative to address the quality of health care has become a global  Managing Quality Improvement in Managed Carephenomenon. A quality revolution for delivery of service with patient at the center and services around it is the of the time. Managed care firms and many of their contracted provider groups have been forced to take a much more detailed and aggressive look at how to maximize the value of their product. The evolution of managed cared will evolve as it solidifies its position the organizing template of American health care payment. The evolution of managed cared consist of three stages event driven cost avoidance , value improvement and health improvement. The changes in healthcare financing principles and practices are ironically the product of our health systems success. Background and LiteratureManaged care providers as well as traditional health insurers took a public relation beating during the 1993 -94 health reform debate. Advocates of health reform hammered health insures for abusing the public trust by denying access to insurance for those in need for excessive profits and executive compensations and for bureaucratic interference with doctor patient relationships. While these attacks were obviously designed to justify a marked expansion in federal regulation of health insurance the behavior of managed care firms in the eighties raised legitimate question about their operations. The historic tragedy for generating earnings in managed care relied on two approaches on two approached securing discounted fees and charges from providers and avoiding hospitalization of subcribers after they became sick. This latter strategy we term event driven cost avoidance. Manage care plans have been to reduce hospitalization of their subscribers below the level of the community at large through utilization review and substitution of ambulatory for inpatient services.Most of the measures used to compare the quality of care is delivered health plans are based on population. Employers and managed care plans established the National Committee on  Managing Quality Improvement in Managed CareQuality Assurance NCQA to address quality issues. The NCQA accreditation program takes an important role for employers in deciding which managed care plans to make available to their employees. Under the requirements of this programs plans will must demonstrate that they have a quality system in place that actually enhances performance and results in systemic quality improvement. As the measures in the quality improve over time with factual collection of data and collaboration of provider and networks the current disillusionment about managed care and the quality of care can be put to rest. Challenges Associated with the topicThe main question for many is in the quest to save money has the quality of health care been sacrificed ? Federal and state goverments have recently mounted strenuous efforts to control perceived abuses in managed health care. Examples such as hospital maternity stays that are to brief restrictions on how physicians may advise their patients about treatment options and certain payment schemes that reward physicians for limiting the medical services they provide. This flood activity of activity seems to suggest that serious problems in American medicine are limited to managed care. Quality problems take three forms underuse, overuse, and misuse. Underuse is the failure to provide a service whose benefit is greater than its risk. Overuse occurs when a health service is provided badly, and an avoidable complication reduces the benefit the patient receives. It took exposes of poor quality and questions from purchasers about what they were getting got their money to push performance measurement ahead. Now that we appreciate the need and importance to perform measures on the quality of care it is important to question why after a decade of work there no effective measurement tools is still. The reason is not the lack of brains but the fact that performance measure is just difficult.  Managing Quality Improvement in Managed CareJustification The design of a performance measure and how good it is depending on several factors the purpose of the measure the entity, whose quality is being measured and who will use the measure. It is important to identify these because a measure that is good for one purpose entity dimension or audience might be bad for another.One of the main purposes to conduct and improve the quality of managed care is to compare the delivery of care by different entities such as health plans medical groups hospital and physicians. It is preferred to measure health outcomes because they are what people really care about. Research suggests that injuries attributable to medication complications occur at a rate of nearly 2,000 per year in each large urban teaching hospital and that about 28 percent of them are preventable . An almost equal number of serious errors occur in the administration of medications that do not result in patient injuries but have the potential to do so. Correcting problems like these greatly improves health outcomes and saves money.  Managing Quality Improvement in Managed Care          Arts & Humanities Communications Public Relations HSM 420 Share QuestionEmailCopy link Comments (0)