Download Final report : evaluation of tools and metrics to support by Soeren Mattke, Kristin R. Van Busum, Grant Martsolf PDF

By Soeren Mattke, Kristin R. Van Busum, Grant Martsolf

The sufferer security and reasonable Care Act (ACA) locations robust emphasis on caliber of care as a way to enhance results for americans and advertise the monetary sustainability of our health and wellbeing care procedure. incorporated within the ACA are new disclosure necessities that require wellbeing and fitness plans to supply a precis of advantages and insurance that effectively describes the advantages lower than the plan or insurance. those requirements  Read more...

Introduction --
Technical strategy --
Conceptual Framework --
Provider-Facing Structural features of wellbeing and fitness Plans --
Member-Facing Structural features of health and wellbeing Plans --
Process Measures --
Outcomes Measures --
State of perform in organisation Decisionmaking approximately healthiness Plans --
Conclusions --
Appendix A: Description of precis of advantages and assurance and word list of phrases --
Appendix B: Description of seek techniques and instruments --
Appendix C: Descriptions of caliber size and Reporting companies --
Appendix D: Descriptions of caliber dimension and Reporting businesses.

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Additional resources for Final report : evaluation of tools and metrics to support employer selection of health plans

Example text

Adherence to evidence-based care, also referred to as the “effectiveness of care,” is defined as "providing services based on scientific knowledge to all who could benefit" (Institute of Medicine Committee on Quality of Health Care in America, 2001). In lay terms, effective care might be described as "care that has been proven to work" (Hibbard J and Sofaer S, 2010). The “best scientific knowledge” can be developed based on laboratory tests, clinical trials, epidemiological research, and outcomes research.

Results matter most. In the view of our experts at the panel meeting, the primary question to be asked regarding quality of care should be whether care provided under a health plan meets evidence-based standards of care, achieves adequate disease control and member experience, and ensures prudent stewardship of resources. Thus, details on structural characteristics, although important, should not be a central component of evaluating quality of care in relation to other measures of quality. In addition, a focus on detailing structural characteristics carries the risk of stifling innovation, as health insurers might feel compelled to design plans that have certain criteria rather than try out novel ideas that improve results.

As a consequence, overuse measures get challenged during the development and review process as potentially creating obstacles to appropriate care, and it is difficult to get them accepted by review committees unless they can specify precisely under which condition a procedure is and is not appropriate. Our panel discussion revealed that overuse measures commonly get rejected in the NQF review process for that very reason. At the same time, patients’ demand for services and their pervasive belief that “more care is better care” can undermine the rationale for the development of overuse measures.

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