Donabedian Model of Quality
Until recently, cost and access have been treated as the most important aspects of healthcare in the United States. However, quality of care has quickly gained recognition as another important aspect in improving access and controlling the cost of healthcare (Shi & Singh, 2015, p. 464). Many people believe that higher quality is synonymous with higher cost; in other words, you get what you pay for. However, Shi & Singh (2015) tell us that, “The principles of cost efficiency indicate that health care costs can be reduced without lowering quality of care” (p. 496).
In order to improve the quality of care, it is necessary to measure and evaluate the outcomes of patients and populations. The Donabedian quality model …show more content…
The Centers for Medicare and Medicaid Services (CMS) implemented quality measures under Medicare, as well as various states under Medicaid. These quality measures incentivize providers through reimbursement in what is known as pay-for-performance. This value-based purchase program, ties quality measures with hospital reimbursement (Shi & Singh, 2015, p. 481). According to CMS’s website, there are thirty-three quality measures covering four separate quality sections, including, “patient/caregiver experience, care coordination/patient safety, preventive health, and at-risk population” (2015, para. 1). These measures are tacked through surveys, claims, electronic health records (EHRs), and through the ACO Group Practice Reporting Option (GPRO) Web Interface (Centers for Medicare and Medicaid Services website, 2015). One specific example of a CMS quality measure is hospital readmissions within thirty days. The CMS outcome measurement states …show more content…
According to the Center for Health Care Strategies, Inc. (CHCS), “Members of racial and ethnic subgroups encounter more barriers to care, greater incidence of chronic disease, lower quality of care, and higher mortality than white Americans” (Martin, 2007, p. 5). CHCS set out to improve the outcomes by reducing disparities for the Medicaid medical management population through quality initiatives. The quality initiatives were targeted toward outcome measures for birth and immunizations, asthma care, and diabetes care. However, in order to begin the process, they needed access to reliable data, including information collected through the state Medicaid enrollment process, as well as data collected directly from the Medicaid enrollees. Once the data was collected it was analyzed against established standards in a quality assessment (Shi & Singh, 2015, p. 493). Through this assessment, they decided to implement and test patient-centered care models targeted to meet the needs of the specific population, and found that quality was improved (Martin, 2007, p. 13). The hope is that these quality initiatives will help the entire Medicaid
Until recently, cost and access have been treated as the most important aspects of healthcare in the United States. However, quality of care has quickly gained recognition as another important aspect in improving access and controlling the cost of healthcare (Shi & Singh, 2015, p. 464). Many people believe that higher quality is synonymous with higher cost; in other words, you get what you pay for. However, Shi & Singh (2015) tell us that, “The principles of cost efficiency indicate that health care costs can be reduced without lowering quality of care” (p. 496).
In order to improve the quality of care, it is necessary to measure and evaluate the outcomes of patients and populations. The Donabedian quality model …show more content…
The Centers for Medicare and Medicaid Services (CMS) implemented quality measures under Medicare, as well as various states under Medicaid. These quality measures incentivize providers through reimbursement in what is known as pay-for-performance. This value-based purchase program, ties quality measures with hospital reimbursement (Shi & Singh, 2015, p. 481). According to CMS’s website, there are thirty-three quality measures covering four separate quality sections, including, “patient/caregiver experience, care coordination/patient safety, preventive health, and at-risk population” (2015, para. 1). These measures are tacked through surveys, claims, electronic health records (EHRs), and through the ACO Group Practice Reporting Option (GPRO) Web Interface (Centers for Medicare and Medicaid Services website, 2015). One specific example of a CMS quality measure is hospital readmissions within thirty days. The CMS outcome measurement states …show more content…
According to the Center for Health Care Strategies, Inc. (CHCS), “Members of racial and ethnic subgroups encounter more barriers to care, greater incidence of chronic disease, lower quality of care, and higher mortality than white Americans” (Martin, 2007, p. 5). CHCS set out to improve the outcomes by reducing disparities for the Medicaid medical management population through quality initiatives. The quality initiatives were targeted toward outcome measures for birth and immunizations, asthma care, and diabetes care. However, in order to begin the process, they needed access to reliable data, including information collected through the state Medicaid enrollment process, as well as data collected directly from the Medicaid enrollees. Once the data was collected it was analyzed against established standards in a quality assessment (Shi & Singh, 2015, p. 493). Through this assessment, they decided to implement and test patient-centered care models targeted to meet the needs of the specific population, and found that quality was improved (Martin, 2007, p. 13). The hope is that these quality initiatives will help the entire Medicaid