Managed Care: Health Care Accreditation

Managed Care Institutional Affiliation Student’s Name Course Name/Number Instructor’s name Date Submitted Managed Care In the United States, Health Care Accreditation is extremely important, reason being, it validates our health care system by guaranteeing that regulations and rules that control the way we care for our patients and service our facilities are followed. Accreditation is an evaluation that is carried out externally and internally by healthcare organizations to assess the level of health care based on established standards (Epstein, 2002). Accreditation is an ongoing program that is utilized to enact change to advance the overall performance of a medical facility. Accreditation does not simply involve the setting of standards; it also contains a self-improvement program and counseling. It is crucial to have an accreditation program as it ensures that facilities are run in a safe manner, and patients are provided with the best care. Accreditation does not only cover the medical aspects of a facility; it further tackles safety issues outside of the medical care process (Landon, 2001). Accreditation is a versatile system that deals with all aspects of the healthcare system. Usually, clinics/facilities have teams that inspect particular areas within them; the inspectors carry checklists that give them specific area and items to look into. The NCQA (National Committee for Quality Assurance) Accreditation appraises the quality of major processes and system health plans provided to their members (Epstein, 2002). The standards are set to assist organizations in achieving the best performance, reducing patient risk, and creating an environment of constant improvement. NCQA appoints a team of trained healthcare experts to conduct a strict on-site survey of every plan considered for accreditation (Epstein, 2002). NCQA accreditation contains standards for utilization management, members’ responsibilities and rights, credentialing and re-credentialing, quality management, and improvement, HEDIS (Health Plan Employer Data Information Set, and CAHPS (Consumer Assessment of Health Plan Services) m...