Utilization and Risk Adjusted Utilization|Course hero helper

Posted: January 28th, 2023

INSTRUCTIONS- Add further clarity to the assignment you just wrote about including HEDIS Please feel free to add questions related to content or assignments.

WHAT YOU ARE CLARIFYING-The National Committee for Quality Assurance (NCQA) was formed to ensure quality of patient care and measurement of patient outcomes with set standards.

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Healthcare Effectiveness Data and Information Set (HEDIS) is a performance measurement tool used by millions of health insurance plans. There are 6 domains of care:

  • Effectiveness of Care.
  • Access/Availability of Care.
  • Experience of Care.
  • Utilization and Risk Adjusted Utilization.
  • Health Plan Descriptive Information.
  • Measures Collected Using Electronic Clinical Data Systems

This week, the course content will focused on the various elements impacting policy priorities, plans for implementation of those policies, the relevant stakeholders, and evaluation of results once the policy is implemented. Coalitions will be examined in terms of their functions and purposes, as well as the power of special interest groups. The value of research and its application to the political process will be explored. Conflict management and working effectively in the context of nursing specialty associations will also be discussed.

1 paragraph assignment


that HEDIS measures:

  1. Effectiveness of Care
  2. Access/Availability of Care
  3. Experience of Care
  4. Utilization and Risk Adjustment
  5. Health Plan Descriptive Information
  6. NCQA Accreditation Survey.

HEDIS measures are used to evaluate and compare the performance of health plans on a variety of clinical and service-related measures. These measures cover a range of topics, including preventive care, chronic disease management, and customer satisfaction. The data collected through HEDIS is used by health plans, employers, and other healthcare stakeholders to improve the quality and effectiveness of care provided to patients.

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