Essay On Quality Management In Managed Care

Quality Management in Managed Care Quality management is the collection and evaluation of data with the purpose of defining and then improving outcomes of care. Quality management programs turn data into information that can be used to make changes in practice (Dutton, 2013). The main purpose of quality management programs is to improve patient care. Patient care can be improved by incorporating the six goals recommended by the Institute of Medicine into quality management programs. The six goals include safety, effective, patient-centered, timely, efficient, and equitable care. The purpose of this paper is to analyze the key components of a quality management program, and to compare the characteristics of a quality management program from

Modern quality management programs use continuous improvement process models to improve processes and services. The first step in the continuous improvement process involves understanding customer need. Understanding customer need is the basis of all quality management programs. Customers include all external customers, internal customers, and suppliers that are touched by the service. Many managed care organizations evaluate customer needs through surveys. The second step involves identifying and evaluating processes and outcomes that meet customer need. Managed care organizations must evaluate access to services, and they must evaluate the appropriateness of care provided to members. The third step of continuous quality improvement involves the assessment of performance compared with a professional standard (Kongstvedt, 2013). The assessment of performance is accomplished through appropriateness review, peer review, and benchmarking. The main difference between peer review in a traditional quality assurance model and a modern quality management program is the topic of comparison (Kongstvedt, 2013). The fourth step of continuous quality improvement is outlining indicators to measure performance. The organization can apply the structure, process and outcome criteria when defining indicators. The fifth step is establishing performance expectations. The first three steps of the continuous improvement process help define the organization’s performance expectations. The sixth step of continuous quality improvement is monitoring performance. Performance is evaluated and compared with expectations. The seventh step is providing feedback. Feedback is provided through profiling and report cards. The last step of continuous quality improvement is