HCFA recognizes best practices among MCOs
With all the bad press managed care companies have garnered lately, you might be inclined to believe they can do little right. Not so, says the Health Care Financing Administration (HCFA) in a new report, A Collection of Best Practices of Managed Care Organizations.
The report identifies eight health maintenance organizations and insurers employing managed care techniques that have outstanding operations in such areas as physician profiling, outcomes measurement, case management, technology assessment, and screening and prevention.
But the report stops short of a Good Housekeeping seal of approval, saying there is a lot of work to be done. "HCFA will consider the directions and strengths reflected in these activities in developing its policies and practices regarding managed care organizations," the report said, while calling for "additional, more extensive, and rigorous studies of best practices among managed-care organizations."
Data from each of the "best practices" companies is formatted for easy comparisons of results, success factors, lessons learned, and, in most cases, cost of implementation. HFCA found that many of the recognized companies shared a commitment to total quality management programs and a tight focus on clinical performance and cost efficiency. (See chart, below.)
Other findings: Some managed care organizations (MCOs) use data-based outcomes measures to select and pay providers; some of the companies continually refine utilization management through case-mix severity adjustments; and some MCOs have been very successful in using artificial intelligence and information networks.
To receive the report, contact the National Technical Information Service at (703) 487-4650. Cost is $35, and the order number is PB96-189279KCL.
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