Managed Care Quality Analysis

In the past few years there has been increasing discussion about how to provide adequate care for the increasing number of veterasn who are eligible for care through the Veterans’ healthcare administration (VHA). There are concerns is that the VHA is not providing the level of access, efficiency, and quality of care that veterans expect. Lee & Begley, (2016) suggest access to care for the veteran population may be resulting in poor health outcomes. In response to these concerns, the Veterans ' Access to Care through Choice, Accountability, and Transparency Act (VACAA) of 2014, also known as the Veterans Choice Act, was created to improve Veterans’ healthcare. The VACAA proposed to do this by expanding the number of options veterans have for receiving healthcare, by providing access for healthcare at non-VA care centers as well as providing for an increase in staffing at VA facilities (U. S. Department of Veterans Affairs, 2016).

One of the most serious problems facing all veterans today is the lack of proper healthcare. Soldiers, sailors and airmen are leaving active duty without having proper healthcare to cover their physical or mental injuries. The department responsible for veteran’s healthcare is the Department of Veterans Affairs. (VA) According to The department of Veterans Affairs website, “The United States Department of Veterans Affairs (VA) is a government-run military veteran benefit system with Cabinet-level status. It is responsible for administering programs of veterans’ benefits for veterans, their families, and survivors. The benefits provided include disability compensation, pension, education, home loans, life insurance, vocational

Veterans Affairs is infamous for corruption and public scandals, yet have high rankings of overall patient satisfaction from outside reports. The Congressional Research Service estimates that there are about 21 million veterans in the United States and only 9 million veterans are enrolled in the VA. Only 5 million veterans actually received care during 2014’s fiscal year. “In a given year, not every VA-enrolled veteran receives VA health care services. Some veterans may opt not to seek care during the year, while others may receive care outside the VA system, paying for care using private health insurance, Medicare, Medicaid, the military health system”

In the United States, Veteran’s health care at an economical rate is a continuous debate. It is warranted that the health care should improve at a constant rate to uphold the health needs of veterans, new and old. Government has the veterans association (VA) and with all the help it has available for veterans there are still times when that care is not enough. There are so many individuals that are without health care because of one reason for another and it leaves many injured and hurt veterans without the care they need and deserve. Better access to health for veterans, men and women is important since many new problems such as PTSD have become better understood and need more focus and to be better

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

The Veterans Health Administration is the largest health care system in the U.S., with 92 million visits between 6.4 million patients in 2013. The VA has been blasted in the media lately due to various problems, some would argue that it should be dismantled others reformed. A veteran should not be forced to deal with the political posturing and backbiting that goes along with any bureaucracy. The Veteran Affairs or VA must come to grips with the problems it faces, an insufficient amount of health care workers to handle the increasing number of patient visits, a mismanagement of funds and services, and ineffective, unqualified or just plain poorly trained employees.

Definitions of the quality of medical care are no longer left to clinicians who decide for themselves what technical performance constitutes “good care.” What are the other dimensions of quality care and why are they important? What has changed since the days when “doctor knows best?”

Quality measures are strategies that gauge, evaluate or compute health care processes, results, discernments, patient insight, and administrative structure. In addition, quality measures are frameworks that are connected with the capacity to deliver first-class health care and/or that are able to identify with one or more quality objectives for medicinal services. These objectives include: compelling, protected, effective, quiet focused, impartial, and opportune consideration. Quality measures can be used to measure quality improvement, public reporting, and pay-for-reporting programs specific for health care providers (CMS.gov, 2016). There are an assortment of quality measures in which health care organizations can use to determine the status of the care they are delivering. Many are appropriate, but few are chosen for this research paper. Among them are: National Health Care Surveys, Hospital IQR Programs, Scorecards, and Political, Power, and Perception/Data for Decision-making tools.

Although all dimensions are important to the health care system, I personally think that quality of care is the most important. The quality of care provided by a healthcare provider may influence your health. Having adequate resources is useless if they are in the hands of a provider who, simply, is not capable of improving medical conditions. The United Kingdom received the highest overall rank in this dimension. The United Kingdom implements several policies that “commit to ensuring and continuously improving the quality of care” (OECD, 2016). Several of the UK’s policy areas focus on clinical guidelines, the continuous professional growth and development, and primary care monitoring (OECD, 2016). The United Kingdom’s drive to strengthen

There is a considerable amount of literature that compares the quality of health care in the USA with the quality of healthcare provided in United Kingdom (Komaromy, 2001). Technical quality in the studies and effectiveness is fetched from data obtained from registries of diseases or medical records from administrative data (Harrington, Estes 2008). These studies focus on a specific condition such as coronary heart disease or some cancer complications; they are different in the extent in which they aim to account for indicators that are not within the reach of the care providers that could hinder the result (Harrington, Estes 2008). A very important factor in the measurement of healthcare quality is the difficulty in adjusting to

The access of healthcare has always been a challenge for people of low income and minority status because they typically suffer from poor health and chronic diseases. Managed care implemented a health care ordinance that would allow individuals who are uninsured to receive quality of care through a health care plan. TennCare was the healthcare plan that replaced Medicaid in the state of Tennessee, which provided healthcare coverage for those in need. The healthcare coverage provides accessibility to those of all race and ethnicities, including adults and children. Individuals who enroll to receive TennCare assistance have the meet the eligibility requirements which are calculated by the FPL (federal poverty level). People who meet requirements are able to utilize services provided through the health care plan which include: transportation, prescription drugs, inpatient and outpatient hospitals, laboratory services, and other health care services that are capitated through managed care organizations.

Examining planning for and effectively measuring the health care quality indicators make healthcare quality more transparent and provide information for quality improvement programs and initiatives in the healthcare system.

On the example of quality and value being the major goals in the healthcare system, the key drivers and root causes for the change are the current low quality and high costs associated with our current healthcare system. Despite having higher costs than the rest of the industrialized world, our outcomes are not better (Squires & Anderson, 2015). While this likely has many social and socioeconomic contributors such as lifestyle choices, poverty, and the way in which our healthcare system developed, there is still great deal of the costs and negative outcomes that are associated with poor quality, medical errors, and the system not fully adapting best practices. There are a few root causes for these individual issues as well as I will briefly

The relationship between the external quality and value initiatives in health care has been widely discussed in academic literature. Actually, this issue is of great importance as it reflects the role of patient satisfaction in healthcare. According to researchers, “in health care, the whole notion of quality has become a source of confusion and sometimes a distraction from genuine value improvement” (McClellan, 2008, p. 23). Quality is affected by patient outcomes and satisfaction. At the same time, quality helps to determine the value in healthcare. Many quality and value initiatives are aimed at reducing health care disparities that exist in American

Quality is one of the most essential elements of healthcare. As stated by the Agency of Health Research and Quality, “Everyday, millions of Americans receive high-quality health care that helps to maintain or restore their health and ability to function” (Agency of Health Research and Quality, 2014). Improvements have become vital to the success of health care organizations and in the Healthcare Quality Book, it is explained that quality in the U.S. healthcare system is not at the standard that it should be (Ransom, Joshi, Nash & Ransom, 2008). Although this has been a reoccurring issue, attempts to fix the insufficiency have been less successful than expected.