Competitiveness In Health Care

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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
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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 individual’s response to treatment. Treatment plans are guided by either the American Academy of Pediatrics or the American Medical Association. They are used to guide physicians, in additional to their medical training on the process of treatments. Ensuring individuals continue to follow treatment plans; their physician is required to provide the patient with the plan of care. The needed of follow up appointments, referral to additional sources of care and SOAP (Subjective, Object, Assessment, Plan) charting. For example, there may be a need for a specialist, a needed diagnostic, and or laboratory tests to conclude the diagnosis. At the heart of the matter is the trust a patient is being treated appropriately, by the correct treatment protocols, they are responding and making a wellness progression, or new protocols are set based on their outcomes. As a patient in the office, how do I know my physician is ok to practice, he is prescribing the correct drug remedies or treatments for my disease? The continuum of care is documented on the patient’s chart, which is primarily kept in the physician’s office, and is not seen by another party; unless the patient requests a copy of their medical records. Prior to 1993, this was the

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