Hcs 451 Risk And Quality Management Assessment
Vanessa Beckley
Risk and Quality Management Assessment Summary
HCS/451
November 10, 2014
Risk and Quality Management Assessment
What is a managed care organization? Managed care organization is the entity which integrates the finance and delivery functions of health care. Managed care organizations are providers that put together health care finance and delivery, that is, they combine the payer arm of the health care system with the provider arm. This involves contracting with health care providers to deliver health care services on a capitates basis. MCOs employ utilization management techniques in an attempt to deliver quality care at lower cost than traditional systems (Managed care organization (MCO). Centene Corporation …show more content…
Risk management programs were developed to help the organization prevent risk and loss of revenue. Quality management ensures that an organization, product or service is consistent. Managed care, often seen primarily as a cost cutting initiative struggles to prove to the community at large that managing quality is as important as managing costs of healthcare. In managed care organization below are the main responsible and function of quality improvement ("Managed Care and Quality Management", …show more content…
It differs from QA in its scope, focus, approach and end result. The scope is organization-wide rather than in select departments. The focus is on identifying common causes and on processes, rather than on outliers and clinical outcomes. The approach is proactive rather than reactive. And QI 's end result is to prevent errors and to improve rather than to inspect and repair problems and meet standards ("Managed Care and Quality Management",
Risk and Quality Management Assessment Summary
HCS/451
November 10, 2014
Risk and Quality Management Assessment
What is a managed care organization? Managed care organization is the entity which integrates the finance and delivery functions of health care. Managed care organizations are providers that put together health care finance and delivery, that is, they combine the payer arm of the health care system with the provider arm. This involves contracting with health care providers to deliver health care services on a capitates basis. MCOs employ utilization management techniques in an attempt to deliver quality care at lower cost than traditional systems (Managed care organization (MCO). Centene Corporation …show more content…
Risk management programs were developed to help the organization prevent risk and loss of revenue. Quality management ensures that an organization, product or service is consistent. Managed care, often seen primarily as a cost cutting initiative struggles to prove to the community at large that managing quality is as important as managing costs of healthcare. In managed care organization below are the main responsible and function of quality improvement ("Managed Care and Quality Management", …show more content…
It differs from QA in its scope, focus, approach and end result. The scope is organization-wide rather than in select departments. The focus is on identifying common causes and on processes, rather than on outliers and clinical outcomes. The approach is proactive rather than reactive. And QI 's end result is to prevent errors and to improve rather than to inspect and repair problems and meet standards ("Managed Care and Quality Management",