Synthesis and Documentation of the PHRED (Prepaid Health Research, Evaluation, and Demonstration) Quality Assurance Demonstration. HMO (Health Maintenance Organization) Quality Assurance Demonstration: A Synthesis

摘要

This report summarizes one of the major demonstrations of the Prepaid Health Research, Evaluation, and Demonstration(PHRED) Project. The demonstration addressed the issue of the techniques that could be used by a State Medicaid agency to monitor the quality of care in Health Maintenance Organizations contracting to provide benefits to Medicaid eligibles. The essence of the demonstration was to take a criteria set developed for this project and develop and implement two quite different approaches to obtain the data necessary to apply the criteria. A brief synthesis of the various concepts and techniques that were involved in the PHRED QA demonstration and discussion of their potential application in other settings is included in this report.