AFTER DECADES of serving as the checkbook for millions of Americans' health care, the federal Health Care Financing Administration (HCFA) wants to ensure that its beneficiaries get the most bang for the buck.
Toward that end, Congress recently approved a budget act with a mandate that HCFA establish quality requirements for managed care organizations that provide health care for people enrolled in Medicare and Medicaid.
Both programs already use the Health Plan Employer Data Information Set (HEDIS)—created by the National Committee for Quality Assurance—as a means to measure the performance of managed care plans that serve their beneficiaries. But HCFA's new mandate, known as the Quality Improvement System in Managed Care (QISMC), will require that participating health plans show evidence of improvement in the health care they provide.
The initiative "moves from a structural process to the next generation of standards requiring managed care organizations to improve health care," said