Although the premise of managed care is not new, its broad application is a more recent phenomenon. Shi and Singh (2019) state that the fundamental driver of managed care expansion was high expense increases under the overall fee-for-service system in the 1970s and 1980s. Employers, who in many cases paid the entire cost of health insurance premiums on their workers’ accounts, began shifting to managed care only after seeing significant increases in premium expenses. The overall cost of private health insurance climbed at a pace of more than twelve percent per year on average between 1080 and 1990 (Shi & Singh, 2019). Employers were obliged to switch from indemnity insurance to managed care because of economic circumstances. Moreover, physicians initially resisted managed care, but as healthcare finance switched rapidly toward managed care, they found themselves unable to withstand the mounting pressure.
Continuous quality improvement (CQI) is a quality strategy in which members of the healthcare team are continually asked to identify how to obtain better outcomes. Hincapie et al. (2021) acknowledge that medication mistakes are recognized as the cause of seven thousand fatalities in the United States each year. Continuous quality improvement (CQI) is a management system based on reviewing the organization’s process flow on a regular and constant basis (Hincapie et al., 2021). O’Donnell and Gupta (2022) add that CQI is a method of gradually improving procedures, safety, and patient care. Thus, CQI aims to enhance operations, outputs, system procedures, the work environment, or regulatory requirements.
Hospitals play an essential role in advancing CQI health outcomes and modernizing U.S healthcare delivery models. According to studies, individuals with chronic diseases had fewer hospitalizations, while older patients had fewer emergency department visits to hospitals with CQI. Furthermore, studies show enhanced personnel competencies, capacity, and excitement for providing best practice primary care (McCalman et al., 2018). Improved organizational efficiency results from the availability of high-quality, timely available information, such as the self-sustaining ability to observe, evaluate, and remedy quality concerns by more efficiently regulating and distributing available resources (McCalman et al., 2018). Hospitals examine patient and other health information as well as the processes that are utilized to deliver healthcare. They use this information to discover opportunities for improvement and to underline areas of strength.
Thus, CQI aims to enhance clinical outcomes, increase efficiency in healthcare in the country, and lower expenditures. Hospitals may identify the best approaches in care through benchmarking and uncover research opportunities that increase professional knowledge and support the development of upcoming best practices by examining variations in quality measurements (CMS, 2021). The obligation to pursue righteousness and exercise justice and kindness to all is a biblical principle connected to healthcare. Hence, healthcare providers obtain insights to improve performance via quality measure monitoring.
The rate of integration in the United States’ healthcare system has accelerated. Shi and Singh (2019) claim that the continual transformation of the whole system toward value-based payment models and population health accountability may be the fundamental cause for the push toward integration. Many organizations have realized that collaboration with other providers enables them to share best practices, synchronize information systems, enhance supply chain purchasing power, and minimize the cost of providing healthcare to their patient population in this evolving landscape (Shi & Singh, 2019). One central element that prompted integration among health care providers was the rising dominance of managed care. In recent years, the rate of integration between clinicians, hospitals, and other providers has increased and will evolve in the future (Shi & Singh, 2019). Highly integrated firms are held accountable for meeting particular goals in terms of cost, quality, and customer satisfaction. Nevertheless, cost minimization remains an elusive aim, possibly because the United States healthcare delivery system continues to be hampered by an increased emphasis on specialization and the overuse of costly technologies.
CMS. (2021). Quality measurement and quality improvement. Web.
Hincapie, A. L., Alyami, F., Alrasheed, M., Hegener, M., Beaton, C., O’Brien, L., & MacKinnon, N. J. (2021). Continuous quality improvement regulations for community pharmacy practice in the United States. Journal of the American Pharmacists Association 61(4). Web.
McCalman, J., Bailie, R., Bainbridge, R., McPhail-Bell, K., Percival, N., Askew, D., Fagan, R., & Tsey, K. (2018). Continuous quality improvement and comprehensive primary health care: A systems framework to improve service quality and health outcomes. Frontiers in Public Health, 6(76). Web.
O’Donnell, B., & Gupta, V. (2022). Continuous quality improvement. StatPearls [Internet]. Web.
Shi, L., & Singh, D. A. (2019). Delivering health care in America: A systems approach (7th ed.). Jones & Bartlett Learning.