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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.
Primary Care Case Management (PCCM), is a program of the United States government healthcare service Medicaid.It oversees the United States system of managed care used by state Medicaid agencies in which a primary care provider is responsible for approving and monitoring the care of enrolled Medicaid beneficiaries, typically for a small monthly case management fee in addition to fee-for ...
An estimated 2.2 million children in the United States have lost Medicaid coverage in 2023. "Any disruption in coverage can have serious health consequences, serious health and mental health ...
Primary Care Case Management (PCCM) is a system of managed care in the US used by state Medicaid agencies, in which a primary care provider is responsible for approving and monitoring the care of enrolled Medicaid beneficiaries, typically for a small monthly case management fee in addition to fee-for-service reimbursement for treatment. [1]
Managed care delivery systems grew rapidly in the Medicaid program during the 1990s. In 1991, 2.7 million beneficiaries were enrolled in some form of managed care. Currently, managed care is the most common health care delivery system in Medicaid. In 2007, nearly two-thirds of all Medicaid beneficiaries are enrolled in some form of managed care ...
Medicaid's shift to a managed care delivery system in the 1990s required CHCs to again modify their financial structure. The implementation of managed care in Medicaid was intended to curb costs while providing patients with greater freedom to choose where they access care. [58]
Managed care plans and strategies proliferated and quickly became nearly ubiquitous in the U.S. However, this rapid growth led to a consumer backlash. Because many managed care health plans are provided by for-profit companies, their cost-control efforts are driven by the need to generate profits and not providing health care. [5]
The government is only now starting to collect basic data to gauge the quality of care, more than 30 years after the benefit was introduced. New measures, ushered in under the Affordable Care Act, require hospice operators to submit data that measure seven different conditions for hospice patients, such as pain or shortness of breath.