THE ROLE OF PROVIDERS IN QUALITY ASSURANCE The Role of Providers in Quality Assurance The purpose of the Session Long Project is to evaluate quality for managed care organizations and hospitals.

The Role of Providers in Quality Assurance

Most insured Americans belongs to a managed care plan, the delivery of health care system, which is the practice of corporate business to health care in order to reduce costs and optimize care. Managed care era began in late 1980 in response to a sharp rise in health costs, which stem from several sources. In a service fee, or compensation model that preceded managed care, doctors and hospitals financial rewards for many costly tests and procedures for the treatment of patients. Other members of the high cost of medical care were public health achievement since the Second World War, that lengthening the average life expectancy of Americans. This put increased pressure on health systems. In response, providers have taken the state of modern diagnostic and therapeutic technologies as they become available.

Managed care companies have tried to reduce costs by negotiating lower fees with doctors and hospitals in exchange for a steady flow of patients, standard treatment of specific diseases that require doctors to obtain plan approval prior to hospitalization (except in case of emergency), and encouraging physicians prescribe less expensive drugs. Many plans offer financial incentives to physicians who minimize referrals and diagnostic tests, and some financial sanctions, or obstacles to those considered to have ordered unnecessary care. Primary watchdog and accreditation agencies managed care organizations, the National Committee for Quality Assurance (NCQA), a nonprofit organization that collects and disseminates data on health plan performance.

Three basic types of managed care plans for older people: health care organizations (HMOs), preferred provider organizations (PPOs), and point-of-service (POS) plans.

• HMOs, there are more than 50 ...