Promoting quality through managed care.

Abstract

Managed care organizations will be able to promote quality care as well as control costs by utilizing quality management approaches and practice guidelines. By so doing, organized systems of care could promote adherence to standards of quality and appropriateness. Focusing on systems of care is a major component of the quality improvement process and fits well with the development and utilization of practice guidelines. Practice guidelines, as well as risk management, quality assurance, and quality improvement techniques, can help reduce undesirable variation in practice patterns and prevent problems from occurring. Guidelines may be based on different levels of explicitness ranging from subjective judgment to specific outcomes and patient preferences. The use of guidelines and quality improvement mechanisms will enhance the effectiveness of clinical decision making and enable managed care organizations to work productively with physicians to promote quality.