Plan that continually assesses the effectiveness of inpatient and outpatient health care in managed care plans and federal programs such as TRICARE and CHAMPVA. Also see quality assurance (QA) and quality improvement (QI) .

Created in 1993 by the Health Care Financing Administration to assist states in promoting a health care quality improvement system for Medicaid managed care plans.

Product developed by the National Committee for Quality Assurance (NCQA) that contains commercial, national, regional, and state averages and percentiles. The program contains information from all HEDIS (Health Plan Employer Data and Information Set) measures including utilization data in the Use of Services domain, as well as some selected consumer assessment of health plans survey (CAHPS) rates for plans publicly releasing data. Data are available for purchase in an online format.

Programs to promote quality of health care such as peer review components to find and solve deficiencies in quality and assessment of effectiveness. Formerly known as quality assurance (QA) . Also referred to as performance improvement (PI) and continuous performance improvement (CPI) .

Program formerly known as Utilization and Quality Control Peer Review Organization (PRO) that is designed to review cases to determine appropriateness, medical necessity, and quality of care for Medicare beneficiaries. It consists of groups of practicing doctors and other health care experts. They are paid by the federal government to check and improve the care given to Medicare patients. They must review the patients’ complaints about the quality of care given by inpatient hospitals, hospital outpatient departments, hospital emergency departments, skilled nursing facilities, home health agencies, private fee-for-service plans, and ambulatory surgical centers.

Centers for Medicare and Medicaid Services (CMS) program for health plans that participate in Medicare+Choice. This program features medical care quality measurement, reporting, and improvement requirements to improve health and satisfy Medicare and Medicaid recipients.

Process to determine the quality of medical care, develop and monitor a standard of quality, introduce improvements, and maintain a desired level of excellence. Also referred to as quality program, performance improvement program , or performance management program .

Evaluation of health care services that meet established professional standards and judgments of value to the patient.

1. Measure of the best possible energy that endows a person with the power to cope successfully with the full range of challenges faced in the real world such as personal security, degree of independence, and self-sufficient decision-making. 2. Individual’s expressed satisfaction with the current life situation.

Group of practicing physicians and other health care practitioners who are under contract to the federal government to review medical care given to Medicare patients enrolled as members in managed care plans (e.g., health maintenance organizations [HMOs] and competitive medical plans [CMPs]).