Managed Care – Essay Example

Managed Care Accreditation is a “peer review and voluntary” process whereby organizations, s and programs, following the internationally accepted standards, are approved and granted status by a voluntary, nongovernmental third party, called accrediting agency, (Zerwekh & Claborn, 2006).
2. Accreditation is important because it proves or disproves the organization’s proficiency, neutrality and performance competence; helps reduce risks; and, ensures that customers, providers and buyers can rely on the goods and services being provided by the organization. In other words, accreditation ensures the accountability of organizations to maintain public confidence (WorldWideLearn, 2010) and improve the quality of patient care in health sector (Joint Commission International, 2002).
3. Organizations that accredit managed care organizations in the U.S. include the National Committee for Quality Assurance (NCQA), founded in 1990; the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), founded in 1951; the accreditation Association for Ambulatory Health Care (AAAHC); the American Accreditation Program Inc. (AAPI); and, the Utilization Review Accreditation Commission (URAC) (Dimmitt, 1995).
4. The organization that needs certification submits an application packet to the accrediting agency that confirms whether or not the applicant organization meets the accreditation standards. This is done by looking at the organization’s performance of tasks and procedures regarding improvement in patient care. The accrediting agency makes on-site visits and observations, and conducts interviews.
5. The accreditation status of my health care provider, which is a nursing home located nearby my residence, is under process with NCQA. Its managed care plan has been surveyed and reviewed by NCQA and is waiting for grant of certification.
References
Dimmitt, BS. (1995). Accreditation: whats the big deal? - managed care organizations - includes related article on accreditation organizations. Health Care Industry. Retrieved September 19, 2010 from http://findarticles.com/p/articles/mi_m0903/is_n12_v13/ai_17875512/?tag=content;col1
Joint Commission International. (2002). Joint Commission International Accreditation Standards for Hospitals. USA: Joint Commission Resources.
WorldWideLearn. (2010). What is Accreditation? Retrieved September 19, 2010 from http://www.worldwidelearn.com/accreditation/index.html
Zaerwekh, JG. & Claborn, JC. (2006). What is accreditation? Nursing Today, Transition and Trends. USA: Elsevier Health Sciences.