Search results
Results From The WOW.Com Content Network
Managed care plans and strategies proliferated and quickly became nearly ubiquitous in the U.S. However, this rapid growth led to a consumer backlash. Because many managed care health plans are provided by for-profit companies, their cost-control efforts are driven by the need to generate profits and not providing health care. [5]
The Donabedian model is a conceptual model that provides a framework for examining health services and evaluating quality of health care. [1] According to the model, information about quality of care can be drawn from three categories: "structure", "process", and "outcomes". [2]
Managed care delivery systems grew rapidly in the Medicaid program during the 1990s. In 1991, 2.7 million beneficiaries were enrolled in some form of managed care. Currently, managed care is the most common health care delivery system in Medicaid. In 2007, nearly two-thirds of all Medicaid beneficiaries are enrolled in some form of managed care ...
The term “managed care” originally involved prepaid health plans, typically health maintenance organizations (HMOs). However, the term expanded to include preferred provider organizations (PPOs).
HEDIS 2006 Volume 2: Technical Specifications. The Healthcare Effectiveness Data and Information Set (HEDIS) is a widely used set of performance measures in the managed care industry, developed and maintained by the National Committee for Quality Assurance (NCQA).
The generic model used in the United States is the chronic care model, which holds that health care does not only involve change in the patient and that high-quality disease care counts the community, the health system, self-management support, delivery system design, decision support, and clinical information systems as important elements in ...
Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
Nurse-managed health centers also focus on preventive health care, especially regarding certain chronic conditions like asthma, hypertension, diabetes, and obesity. This focus on preventative, holistic health care has been shown to reduce emergency room usage and decrease the length of hospital stays among nurse-managed health center patients. [13]