Accredit Managed Care Organizations SL Essay Example | Topics and Well Written Essays - 500 words

Accredit Managed Care Organizations SL - Essay Example Since the organizations want to acquire and maintain accreditation, they improve the standards of their services. In so doing, patients end up getting improved care, which is to their benefit. The process of accreditation by NCQA is in two parts. The basis for assessment of each plan is on standards and healthcare effectiveness data and information set (HEDIS). Standards involve the evaluation of the structure and process of a plan in the maintenance and improvement of quality. HEDIS involves evaluating the performance of a plan with regard to the process and outcomes in member experience of care as well as outcomes in clinical care (NSQA, 2008). The NCQA carries out its survey through onsite and offsite evaluations. In the offsite evaluation, the team of surveyors assesses the self-evaluation and other materials that concern the plan. The materials required for the process are accessible through the Interactive survey System, through which the institutions make submissions. The team reviews the plan’s documents, which the institution submits, against standards to ascertain compliance. When evaluating standards, NCQA focuses on quality management and improvement, u tilization management, credentialing, as well as member connections. The Healthcare Effectiveness Data and Information Set on its part assesses areas of care (NCQA, 2008). It focuses on preventive services such as immunization, treatment of acute diseases, management of chronic ailments as well as patience experience. During the on-site review, NCQA assesses various areas of operation as well as documents and material that the institution may not be able to submit through the Interactive Survey System. That includes confidential documents such as minutes of meetings or actual case records. The team of managed care experts and physicians assess the documents against the specifications of the plan as the institution