Managed Care and Quality Improvement

Managed care is often seen primarily as a cost cutting initiative that is concerned with managing cost and cost only in the healthcare field. For this and a few more reasons managed care organizations face severe judging on the quality of care that they provide. When analyzed correctly, trends prove that managed care has in fact been very significant in determining and improving the quality of care. In this paper, elements such as the state and federal oversights over MCOs, voluntary accreditations, standardized performance indicators and examples of successful quality programs developed by MCOs will be used to prove this statement. Though in the eyes of many managed care and quality do not go together, the research information provided in this paper will show that MCOs are placing more emphasis on measuring and improving the quality of healthcare and therefore should be considered as an important force in such.

Most of the managed care industry is governed and handled by for-profit organizations, which leads many to believe it focuses more on managing costs and obtaining profit than in the quality of care provided to individuals. To add to this, MCOs legal policies place them in the predicament of having to put stockholders before consumers and/or payers. Furthermore, recent studies suggest that ever since the shift of financial risk to providers through the process of capitation, such have become even more financially free to not provide all the necessary care needed. However, the managed care industry has counterattacked these statements by demonstrating throughout these years that it is in fact not only about managing costs, but also about managing quality and improving it as well. As time passes it has been noted that MCOs...

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...he status of the healthcare system today indicate that managed care organizations actually play a very important role in the healthcare system and the care it delivers to beneficiaries and patients. Improvements in the quality of care continue to increase across the spectrum but while there is much to celebrate about, there is also a lot to work and better in. Partnerships and compromises among MCOs, hospitals, insurance companies, health plans, practitioners, consumers and purchasers must be made to fill in the gaps and fill the areas that are still far from perfected. Needless to say, the healthcare system will never reach complete perfection because it is an ever-changing industry that adapts and transforms through time, but if all the components joint and work together then the mission of providing every patient with the best care possible will be fulfilled.