Achieving and Maintaining Accreditation in Managed Care
Achieving and Maintaining Accreditation in Managed Care
Accreditation is a process by which an impartial organization (URAC) will review a company’s operations to ensure that the company is conducting business in a manner consistent with national standards. For a physician and a nurse after they receive their degree they have to do continuing education courses every year to maintain their licensing with that particular state. These classes are generally known as CME’s (Continuing medical education). They serve to “maintain, develop, or increase the knowledge, skills, and professional performance and relationships that a physician uses to provide services for patients, the public, or the profession” (ACCME). That being said physicians cannot do continuing education that does not relate to their profession and receive credit from them. There are committees and Organizations depending on what area they work in. There is the National Committee for Quality Assurance (NCQA), Accreditation Association for Ambulatory Health Care (AAAHC) and Managed Behavioral Health Care Organizations (MBHCO), just to name a few. Managed Care plans are “health insurance plans that contract with health care providers and medical facilities to provide care for members at reduced costs. These providers make up the plan’s network” (Medline Plus, 2013). We have all had to choose at one point with HMO’s (health Maintenance Organization) and PPO’s(Preferred Provider Organizations), and each person will have a difference in opinion on what they consider the best. Physicians want to work with the one that will help them get more business in their specific area. If there are large businesses in the area, they typically want to use an HMO. So once the physician has decided on their area and picked which way they would like to go, they must now become a part of the managed care systems.
NCQA is a non-profit organization dedicated to improving healthcare quality, it accredits
Accreditation is a process by which an impartial organization (URAC) will review a company’s operations to ensure that the company is conducting business in a manner consistent with national standards. For a physician and a nurse after they receive their degree they have to do continuing education courses every year to maintain their licensing with that particular state. These classes are generally known as CME’s (Continuing medical education). They serve to “maintain, develop, or increase the knowledge, skills, and professional performance and relationships that a physician uses to provide services for patients, the public, or the profession” (ACCME). That being said physicians cannot do continuing education that does not relate to their profession and receive credit from them. There are committees and Organizations depending on what area they work in. There is the National Committee for Quality Assurance (NCQA), Accreditation Association for Ambulatory Health Care (AAAHC) and Managed Behavioral Health Care Organizations (MBHCO), just to name a few. Managed Care plans are “health insurance plans that contract with health care providers and medical facilities to provide care for members at reduced costs. These providers make up the plan’s network” (Medline Plus, 2013). We have all had to choose at one point with HMO’s (health Maintenance Organization) and PPO’s(Preferred Provider Organizations), and each person will have a difference in opinion on what they consider the best. Physicians want to work with the one that will help them get more business in their specific area. If there are large businesses in the area, they typically want to use an HMO. So once the physician has decided on their area and picked which way they would like to go, they must now become a part of the managed care systems.
NCQA is a non-profit organization dedicated to improving healthcare quality, it accredits
Cited: Medline Plus. (2013, June 12). Retrieved from http://www.nlm.nih.gov/medlineplus/managedcare.html AAAHC. (n.d.). Retrieved from Accreditation Association Ambulatory Health Care, INC.: http://www.aaahc.org/about/history/ ACCME. (n.d.). Retrieved from Accreditation Council for Continuing Medical Education: http://www.accme.org/requirements/accreditation-requirements-cme-providers/policies-and-definitions/cme-content-definition-and-examples NCQA. (n.d.). Retrieved from Measuring quality Improving health care: http://www.ncqa.org/AboutNCQA.aspx NCSBN. (n.d.). Retrieved from What you Need to know about Nursing Licensure and Boards of Nursing: https://www.ncsbn.org/Nursing_Licensure.pdf Peterson, D. (n.d.). Continuing Education. Retrieved from About.com: http://adulted.about.com/od/professionalcertifications/p/ceu.htm