Healthcare Quality Assurance Article Review
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Managed care is a system of delivering healthcare by organizations knows as Health Maintenance Organizations (HMO) that provide healthcare in the form of customized packages known as health plans. There are also two other plans: a Point of Service plan (POS) and a Preferred Provider Organization (PPO). The cost of delivery is combined with provision of quality in the healthcare. In the course of supervising, monitoring and advising, managed care programs strive to guarantee a certain standard of care, measure performance, and control costs.
The article “Managed Care Features and Chronic Conditions: Effects on Quality of Care and Patient Outcomes” discusses the research performed by seven teams to help in these specific areas. The article specifically pinpoints chronic illness as “millions of chronically ill Americans depend on managed care plans for their care” (Unknown, 2004, p.1). Chronic illness can be described as an illness that lasts for a very long time and usually cannot be cured completely. Chronic illness often seems to instigate suddenly, and the course of illness is long and impulsive. Due to the fact that chronic illness affects millions,
“the Agency for Healthcare Research and Quality (AHRQ), the American Association of Health Plans Foundation (AAHPF), and the Health Resources and Services Administration (HRSA) awarded seven research teams over $10 million to investigate the effects of various features of managed care on the outcomes of care and satisfaction.” (Unknown, 2004, p. 1)
Each team focused on a specific topic to research and study. One team focused on health plans and how they affect hypertension and diabetes care. Through research, the team discovered four features of managed care including financial arrangements for providers, care management strategies, care delivery methods, and cost sharing by patients (Unknown, 2004). Another group focused on the quality of care varying features of managed care organizations that examined “the relationships between patient and medical group characteristics and patient and medical group processes and outcomes” (Unknown, 2004, p.1). Two of the teams chose to research the quality of care for children with special needs in managed care. One team focused on kids participating in a medical program in Florida and the other team focused on kids from California, Massachusetts, and Washington. Another team studied the quality of chronic eye care under managed care will help “deal with the impact of plan features on the process of care in relation to The American Academy of Ophthalmology” (Unknown, 2004, p. 1). The financial incentives and care of chronic cardiac patients was the choice topic for one team which help them develop three goals of the project. The last team chose to investigate the “impact of selected managed care organizational policies on the quality of treatment and health outcomes for Medicaid-enrolled