America's Children Health Insurance and Access to Care (1998) / Chapter Skim
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Appendix B Information for Accountability
Appendix B Information for Accountability
Pages 155-169
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From page 155... ...
The appendix profiles sources of publicly collected data, such as federal surveys, as well as privately collected data collected by health plans anc3 reported to consumers. SOURCES OF DATA ON INSURANCE COVERAGE AND UTILIZATION Meclicaic3 is the largest single insurance program for American children.
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From page 156... ...
Health plans paid through capitation may not report the encounters as EPSDT program screens if they follow other internal reporting guidelines, anc3 capitatec3 providers are paid whether they deliver the EPSDT program services or not. Consequently, information on the effectiveness of EPSDT as a comprehensive program of services for children is not complete.
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From page 157... ...
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From page 161... ...
use of services, anc3 descriptive information about health plans. NCQA has compiled a database with HEDIS data from more than 330 health plans that collectively cover more than 37 million enrollees.
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From page 162... ...
PBGH also manages the collection of HEDIS quality measures for all of the larger California health plans serving commercial enrollees. PBGH makes performance information on plans, medical groups, anc3 hospitals available to the public through a web site anc3 published report carcis.
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From page 163... ...
· U.S. Department of Health and Human Services: Agency for Health Care Policy and Research, Centers for Disease Control and Prevention, Food and Drug Administration, Health Care Financing Administration Medicaid, Health Care Financing Administration Disabled, Health Resources and Services Administration, Indian Health Service, National Institutes of Health, and Substance Abuse and Mental Health Services Administration; · U.S.
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From page 166... ...
. Given the large number of agencies and organizations with interest in anc3/or responsibilities for collecting and analyzing information on aspects of performance in chilciren's health, it is not difficult to see why there is no single entity that has taken overall responsibility for assuring efficient, comprehend sive performance measurement in chilciren's health care.
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From page 167... ...
In early 1998, the Health Care Financing Administration anc3 Health Resources anc3 Services Administration of DHHS began to discuss the development of reporting requirements anc3 other regulatory mechanisms to help monitor the performance of the states in meeting the objectives of the state plans. In abolition to the technical anc3 methodological challenges clescribec3 above, there are other challenges in developing performance measures anc3 other strategies for monitoring methods of account' ability in chilciren's health care.
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From page 168... ...
In the SCHIP program, relevant parties extend from DHHS to states to health plans to providers to enrollees anc3 their families (IOM, 19981. General methods of enforcement of accountability in these relationships include the following: and · setting minimum conditions for clelegation of responsibility through contracting or other means, · setting incentives based on performance.
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From page 169... ...
1997. HEDIS 3.0 (Health Plan Employer Data and Information Set)
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