Last Updated 27 Mar 2020

Managed Care SLP

Essay type Research
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As the second assignment towards completing the Session Long Project, please answer the following in your own words:
1. What is accreditation?
2. Why is it important?

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3. What organizations accredit managed care organizations in the U.S.?
4. What is involved in the accreditation process? (In other words, what do they look at? Do they make site visits?
5. What is the accreditation status of your health care provider organization (hospital, clinic, treatment facility, etc...)? If you are not covered under a managed care plan, identify any managed care plan and explain its accreditation status.

Limit your responses to 1-2 pages. Be sure to properly cite all references.
The following Web sites will help you complete this assignment:
Glossary of managed care terms
What is accreditation?
National Committee for Quality Assurance (NCQA)
What is NCQA & Why is accreditation important?

Joint Commission on Accreditation of Healthcare Organizations (managed care accreditation information).
http://www.jointcommission.org/AboutUs/joint_commission_facts.htm
http://www.jointcommission.org/HTBAC/benefits_accreditation.htm
JCAHO Quality Check to look up accreditation status of facilities www.qualitycheck.org/consumer/searchQCR.aspx
URAC http://www.urac.org/consumer_how.asp
Frequently Asked Questions about Accreditation

http://web.ncqa.org/tabid/65/Default.aspx

http://www.jointcommission.org/AccreditationPrograms/Networks/mco_facts.htm

http://www.urac.org/healthcare/accreditation/

Other resources to help with the assignment:
http://www.ncqa.org/communications/news/clas.htm

What is accreditation?

Accreditation is a procedure in which a neutral organization reviews the standards of care provided by the company.  This process would make sure that the business performed by the company is done as per the standards laid down.

Why is it important?

The public is ensured that the standards of quality is maintained whilst providing medical care
There is some amount of healthy competition in the market
There is a reductions in risks
Patient safety levels are improved
Negligence is reduced
Good practices are encouraged

The process of reviewing the operational activities of the company is performed
Staff recruitment and development may be encouraged
The company may be brought into Medicare certification without undergoing a different review process
Insurers and third parties would automatically recognize the company is accreditation is present
Some states require that a company achieve accreditation so that it could meet the regulatory body’s requirements
Structure and functions in the organization is maintained
What organizations accredit managed care organizations in the U.S.?
Accreditation of managed care organizations in the US is brought about by certain accreditation organizations such as the URAC, Joint Commission and the NCQA.  However, an accreditation organization would be accrediting different types of healthcare organizations.  The organization may be accrediting all the services of the company or a particular service.  Once the company meets certain standards imposed by the accreditations organization, it would receive certification.

What is involved in the accreditation process? (In other words, what do they look at? Do they make site visits?

Before an organization applies for accreditation, it would have to conduct a thorough self-check by ensuring it meets with the standards provided by the accreditation organization. At least some changes would be required.  The entire process of accreditation should be taking about 4 to 6 months.  An application for accreditation is submitted by the healthcare organization.  The reviewers at the accreditation organization conduct a thorough review of the details in the application. This may be an examination of the certificates or an onsite review.  Changes may be required to meet the standards.  Depending on the ability of the company to meet these standards, accreditation is provided.

What is the accreditation status of your health care provider organization (hospital, clinic, treatment facility, etc.)? If you are not covered under a managed care plan, identify any managed care plan and explain its accreditation status.

The company that I work in is accredited by some of the top accreditation organizations in the US.  I do subscribe to a managed care plan, which has been accredited by the Joint Commission.  The Joint Commission looks into several standards provided by the HMO including performance, health promotion, disease prevention, utilization, management of information, education process, HR management, etc.  The Joint Commission interviews the administrative procedures concerned with the plan and the various HR.  The documents are constantly reviewed and the ability to meet with the standards is determined.

References:

NCQA. “About NCQA.” 2007. NCQA. 21 Jul. 2007 http://web.ncqa.org/tabid/65/Default.aspx
The Joint Commission. “Benefits of Joint Commission Accreditation.” 2007. Joint Commission. 21 Jul. 2007 http://www.jointcommission.org/HTBAC/benefits_accreditation.htm

The Joint Commission. “Facts about The Joint Commission.” 2007. Joint Commission. 21 Jul. 2007 http://www.jointcommission.org/AboutUs/joint_commission_facts.htm

The Joint Commission. “Facts about Managed Care Organization Accreditation.” 2007. Joint Commission. 21 Jul. 2007

URAC. “General Questions About URAC Accreditation.” 2007. URAC. 21 Jul. 2007

http://www.urac.org/healthcare/accreditation/

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