National Committee For Quality Assurance Essay

731 Words 3 Pages
Abstract—The choice of a health plan goes undetected by the primary user, who will be greatly affected by their employers choice of coverage. I will examine today’s competitiveness amongst providers, what factors are used for product choice, and the data source involved in the decision making.
Keywords—National Committee for Quality Assurance (NCQA),Data Quality Modeling, Healthcare Effectiveness and Data Information Set(HEDIS), Health Paln Survey, Affordable Care Act(ACA) Centers for Medicare and Medicad Servcies( CMS), Health Maintance Organization, Accrediation, SOAP(Subjective, Object, Assessment, Plan), PPO(perferred provider organization)
I. INTRODUCTION UNDERSTADNING THE HEALTH CARE TREAMENT PROCESS WHICH BEGINS WITH YOUR PHYSICIAN
The healthcare market is a robust environment with carriers listed on the national platform, individual state carriers, military carrier, and the federal government carriers. Health plans are chosen based on their star ratings and HEDIS performance. These are quality of care measuring tools collected from the previous year of clinical data to show member compliance with treatment and provider quality of care. For example, based on a member’s disease process, there are several factors involved in their treatment. Star with a diagnosis: what treatment tools were used to ensure the accuracy in diagnosing? The following are used to obtain a medical diagnosis, laboratory data, clinical occurrences, diagnostic assessments, and the…

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