Cost, Quality and Satisfaction
These issues are at the forefront of health care today. Rising costs in health care may lead to alterations in the care provided and who is providing that care. Regardless of the cost issues, the quality of care and your satisfaction with the caregiver are essential to the optimal outcome of your recovery.
The amount charged by a health care provider encompasses various components of cost. In order to determine fair and equitable costs, the insurance/health plan will reimburse a provider based on ‘market competitive rates.’ The health plan then must monitor the appropriateness and efficiency of the care provided. As the consumer/patient becomes more involved in choosing their providers, it is essential for them to be aware of the anticipated costs. You as the consumer have the right to ask providers about their costs as well as asking the insurance/health plan for what benefits you are entitled. The more informed you are, the better decisions you can make about the health care provided to you or your family.
QUALITY AND SATISFACTION
Health care quality continues to receive considerable attention. What does quality mean in health care? What should consumers do to help improve the quality of health care? According to www.consumer.gov, a website dedicated to consumer information, health care quality is defined as:
Quality health care means doing the right thing, at the right time, in the right way, for the right person - and having the best possible results.
The best way to determine quality of care is to use a measurement survey. There are two general types of measures:
1. Clinical performance measures: these look at the ‘outcomes’ of the treatment provided to determine if there is an improvement in status based on increased function, decreased pain, etc.
2. Consumer satisfaction measures: these are completed by the patient to determine if they received appropriate care, how well their caregiver communicated, etc.
Magellan uses both clinical performance measures and satisfaction surveys to monitor the quality of health care services provided. If you receive health care from an Magellan provider, we will ask for your assistance with completion of these important surveys.
For additional resources on health care quality, visit the government's Agency for Healthcare Research and Quality web site at: www.ahcpr.gov