Managed Care Plan and Accreditation Status

Accreditation and its importance

Accreditation is a detailed procedure through which the standards and overall quality of a healthcare system is assessed to establish whether it is suitable for healthcare provision. In this case, a completely different entity which is not part and parcel of the health care unit is given the task of assessing the health care unit. A health care component like a medical laboratory can be taken through the process of accreditation.

The main rationale behind any accreditation process is to establish whether a health care organisation has the required features which are necessary in the improvement of the quality of managed health care (Navarro 262). The process of accreditation is often not compulsive and the primary standards set are often perceived as possible to achieve. The conditions which are set during accreditation is optimum and aimed at achieving the best results.

One other benefit of accreditation is that it indicates how much a health care organisation is committed to the delivery of high standards of heath care in addition to a secure environment upon which both patients and organisational employees operate. This also go along way in ensuring that a healthcare organisation directs positive effort towards alleviating possible health care risks to both patients and health care providers (Rickel & Wise 90). Accreditation has been regarded as a very viable mechanism through which the right standards of systems can be maintained.

Organizations that accredit managed care organizations in the U.S

The Utilization Review Accreditation Commission (URAC) is one of the largest accrediting organizations for managed care (Shi &Singh 373). It accredits a variety of health organizations. The nature of accreditation depends on the working structure of the managed care organization. Another accrediting body for managed care is the National Committee for Quality Assurance (NCQA). It is a non-governmental organization which was formed in 1990 to assist in pushing for improved health care in U.S. Other accrediting institutions include Healthcare Quality Association on Accreditation (HQAA), Healthcare Facilities Accreditation Program (HFAP) and Accreditation Commission for Health Care (ACHC). All these organizations have a common goal of ensuring that health care standards remain high in all health care organizations (Lundy et al.147).

Briefly explain what is involved in the accreditation process (In other words, what do they look at? Do they make site visits?)

The process of accreditation begins with the actual site visit to qualitatively and quantitatively assess the physical facilities within a particular health care organization. Once this has been established and proved to adequate and up to date, the actual standard of health care services which are offered at the site is analyzed (Joint Commission Resources 142). The results obtained are then compared to the basic set standards which have been universally approved and accepted. The final evaluation of the managed care will entail the right adjustments where necessary before the health care organization can be finally accredited.

Explain the accreditation status of your health care provider organization (hospital, clinic, treatment facility, etc…)? Identify any managed care plan and explain its accreditation status

My local hospital has been accredited by the Utilization Review Accreditation Commission having past the assessment process which was carried out three years ago. The physical facilities like laboratories have been improved and updated in terms of facilities and services offered. Both basic and advanced medical tests can now be carried out in the hospital’s laboratories. Additionally, the use of ambulatory care is of high standard and duly approved by Utilization Review Accreditation commission. The managed care plan in this health care facility also allows for certain referral cases to be handled.

Works Cited

Joint Commission Resources, Inc. Comprehensive Accreditation Manual for Managed Care Organizations 2005-2006. Illinois Joint Commission Mission 2005.

Lundy Saucier Kay, Lundy Saucier Karen and Janes Sharyn. Community Health Nursing: Caring for the Public’s Health. London: Jones and Barlett Publishers, LLC 2009.

Navarro Robert Managed Care Pharmacy Practice. London: Jones and Barlett Publishers, LLC, 2009.

Rickel U Annette and Wise N Thomas. Understanding managed care: an introduction for health care professionals. Washington D.C: Karger, 2000.

Shi Leiyu and Singh A Douglas. Delivering health care in America: a systems approach. London: Jones and Barlett Publishers, LLC 2008.

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