Six steps to maximizing HEDIS results

Article Abstract:

Many health maintenance organizations (HMOs) use the Health Plan Employer Data and Information Set (HEDIS) as a standard for measuring their performance. High HEDIS scores are an important marketing tool when competing for customers with other HMOs. HEDIS data collection, if conducted carefully, will result in higher scores for the HMO. Ways to optimize data collection include determining the most efficient place to examine records, simplifying data collection tools, specifying compliance criteria and familiarizing collectors with the appropriate medical record formats.

Usage, Health maintenance organizations, Performance standards, Job performance standards

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Managed care and total quality management: a necessary integration

Article Abstract:

Managed care should focus on quality improvement and total quality management principles, a process in which nurses play a crucial part. Key issues needing attention include system-level performance measures, use of large databases for quality indicators, demands of health plan purchasers, improvements in clinical outcomes, and consumer satisfaction. The effect on nursing includes the development of new roles for case managers, nurse practitioners and nurse managers or administrators.

Analysis, Total quality management

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What is influencing performance improvement in managed care?

Article Abstract:

Both consumers and medical providers frequently discuss the quality of managed care organizations. Consumers generally worry about access issues, while providers face the challenge of delivering care in a climate of diminishing resources and clamor to improve. The deciding factor for a declining or failing managed care organization may be its compliance with established quality indicators.

Health services administration, Joint Commission on Accreditation of Healthcare Organizations, National Committee for Quality Assurance

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