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The Healthcare Effectiveness Data and Information Set (HEDIS) is a widely used set of performance measures in the managed care industry, developed and maintained by the National Committee for Quality Assurance (NCQA). HEDIS was designed to allow consumers to compare health plan performance to other plans and to national or regional benchmarks.
Health care quality is the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes. [2] Quality of care plays an important role in describing the iron triangle of health care relationships between quality, cost, and accessibility of health care within a community. [3] Researchers ...
National Quality Forum (NQF) is a United States–based non-profit membership organization that promotes patient protections and healthcare quality through measurement and public reporting. [ 1 ] [ 2 ] It was established in 1999 based on recommendations by the President's Advisory Commission on Consumer Protection and Quality in the Health Care ...
The National Committee for Quality Assurance (NCQA) is an independent 501(c)(3) nonprofit organization in the United States that works to improve health care quality through the administration of evidence-based standards, measures, programs, and accreditation. The National Committee for Quality Assurance operates on a formula of measure ...
Insurance industry group America's Health Insurance Plans estimates that administrative costs have averaged approximately 12% of premiums over the last 40 years, with costs shifting away from adjudicating claims and towards medical management, nurse help lines, and negotiating discounted fees with healthcare providers. [232]
Although it is widely recognized and applied in many health care related fields, the Donabedian Model was developed to assess quality of care in clinical practice. [7] The model does not have an implicit definition of quality care so that it can be applied to problems of broad or narrow scope. [6]
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Health insurance coverage is provided by several public and private sources in the United States. Analyzing these statistics is challenging due to multiple survey methods [12] and persons with multiple sources of insurance, such as those with coverage under both an employer plan and Medicaid.