Medicaid Managed Care - U.S. Senate Special Committee on Aging

II. Quality
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<strong>Managed</strong> care plans can offer improved quality
through coordination of care and emphasis
on promoting health. However, financial risk
arrangements can undermine quality of care.
Therefore, managed care plans should
encourage clinical excellence by:
1. using professionally recognized standards
of quality and appropriateness and
meeting recognized certification or accreditation
standards;
2. ensuring that the members of the
health care workforce providing services
within the plan are competent and have
appropriate training, credentialing, and
experience; and that an appropriate number
and mix of health care professionals are
available;
3. providing professional autonomy for
medical and other licensed health care
providers including involving health professionals
in decisions concerning coverage of
services, quality assurance, and other clinical
components of the plan;
4. adopting and implementing quality
assurance and improvement mechanisms
that are created with the input of physicians;
5. structuring physician/provider financial
incentives that support appropriate and
high quality care; and
6. initiating, collecting, analyzing, and
disseminating information regarding patient
care outcomes, patient satisfaction, outcome
of grievances, and complaints.
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