QA in a health maintenance organization IPA model.

Abstract

The PRO is working collaboratively with the American Medical Peer Review Association (AMPRA), the Group Health Association of America (GHAA), the American Medical Care and Review Association (AMCRA) and the California Association of HMOs, Inc. to develop meaningful and acceptable methodology for future review. It has become clear that both the PRO and the HMO must modify systems in order to accomplish stated objectives in the unique IPA setting. Internally, the HMO must rethink management information systems in order to provide data in a timely fashion. The PRO, as well, must strive to understand how an IPA model differs from fee-for-service Medicare review and be prepared to modify exiting systems so defined by their contract with HCFA. Managed care in any model imposes the same responsibility for quality as other health care delivery systems. Only by cooperation and support of the quality process in concert with providers and review organizations can the IPA model measure whether the quality of its services meet professionally recognized standards of health care and whether appropriate health care services have been provided in appropriate settings.