Document Detail


The managed-care perspective for improving quality.
MedLine Citation:
PMID:  11195404     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The role of managed-care organizations (MCOs) is to determine the existence of a benefit and how it is to be covered. Clinical guidelines and evidence-based medicine are critical parts of those decisions, and help drive much of the medical policies of MCOs. The goal is to identify and support medically appropriate and cost-effective interventions, and not cover treatments that do not have those characteristics. This will become increasingly important as more payers move to defined contribution plans, which place added responsibility for care decisions on the medical care consumer. Improving quality, creating consistency, and establishing the credibility of MCOs and their guidelines are imperative for integrating evidence-based medicine into coverage decisions. The ultimate outcome sought by MCOs and payers is improvement of the health of the populations they serve.
Authors:
D van Amerongen
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Oncology (Williston Park, N.Y.)     Volume:  14     ISSN:  0890-9091     ISO Abbreviation:  Oncology (Williston Park, N.Y.)     Publication Date:  2000 Nov 
Date Detail:
Created Date:  2001-01-29     Completed Date:  2001-03-08     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8712059     Medline TA:  Oncology (Williston Park)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  108-9     Citation Subset:  IM    
Affiliation:
ChoiceCare/Humana Inc., Cincinnati, Ohio, USA. dvanamerongen@humana.com
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MeSH Terms
Descriptor/Qualifier:
Data Interpretation, Statistical
Databases, Factual
Evidence-Based Medicine
Humans
Managed Care Programs / organization & administration*,  standards
Patient Education as Topic
Quality Assurance, Health Care
Quality of Health Care*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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