Quality assurance: the measure of quality culture in a managed care setting

Managed care is the health care delivery system in the United States. The e nvironment of care providers in relation to the clients served defines the quality issues of managed care. The ability to manage care is dependent on the metrics of care to understand what services result in positive health o utcomes. The stated goals of cost effectiveness presume knowledge of measur es of health outcomes. The success of managed care is the system of screeni ng clients, authorizing set-vices, and referral to appropriate providers. T he information systems and metrics of care, of appropriate services and of appropriate referrals, have suggested that the metrics of the system is cri tical. Decisions on care which address cost effectiveness require discrete data, which can assist decision-makers on appropriate services and expected outcomes. The metrics commonly used includes econometrics and quality asse ssments. The need to model and to focus on appropriate measures and appropr iate methodologies to analyze these measures is relevant.