DISCUSSION QUESTION 6-2 MH684 Managed Health Care Lesson 6: Regulation, Complian
ID: 246524 • Letter: D
Question
DISCUSSION QUESTION 6-2 MH684 Managed Health Care Lesson 6: Regulation, Compliance, and Accreditation Upon completion of the Required Readings, write a thorough, well-planned narrative answer to the following discussion question. Rely on your Required Readings and the Lecture and Research Update for specific information to answer the discussion question, but turn to your original thoughts when asked to apply, evaluate, analyze, or synthesize the information. Your Discussion Question response should be both grammatically and mechanically correct, and formatted in the same fashion as the question itself. If there is a Part A, your response should identify a Part A, etc. In addition, you must appropriately cite all resources used in your responses and document in a bibliography using APA style. Discussion Question 2 (25 points) What are the five (5) categories for Star Ratings (quality of plan measurements) of NCQA accreditation? Why is each category important and what does it measure? (25 points) (A 1-page response is required.) tected View) DOLEExplanation / Answer
NCQA regulates the requirements of the organization. It improves the quality of service and value. NCQA accreditation measures the quality of health plan through the performance. The five more categories of star ratings for the quality of plan measurements are as follows.
Excellent:
It is the high-level status of the award given to the organization. The organization must meet the clinical needs and services for the consumers. The organization must improve the quality services. HEDIS/CAHPS measures are used for the performance.
Commendable:
NCQA award commendable to the organization which established program and quality services. The organization must improve quality services and protect consumers. The organization is not evaluated by HEDIS/CAHPS measures. The organization has to take further steps to meet the higher performance.
Accredited:
NCQA awards accredited to the organization which meets the basic requirements for the program and the services. But the organization should have quality improvement and consumer protection. The results of HEDIS/CAHPS were evaluated and the organization should take steps to meet the higher performance.
Provisional:
NCQA award of provisional is given to the organization which meets some of the basic requirement of the program of consumer protection and clinical quality. The organization has to improve the overall services and clinical quality to achieve the higher accreditation.
Interim:
The award of interim is given to the organization which is in the place of meeting the expectation of basic requirements for the service and the clinical quality. The organization has to fulfill the expectations within the 18 months period and to execute the requirements successfully.
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