Texas General Lines — Life, Accident, Health and HMOHMOsHard
A Texas HMO is required to establish and maintain a quality assurance program. Which of the following is NOT a primary objective of such a program under state regulations?
- ATo ensure the cost-effectiveness of services by minimizing expensive treatments.
- BTo monitor the accessibility and availability of healthcare services to members.
- CTo evaluate the quality and appropriateness of the care provided.
- DTo resolve member complaints and grievances related to care quality.
Show answer & explanationAnswer & explanation
Correct answer: A. To ensure the cost-effectiveness of services by minimizing expensive treatments.
While cost-effectiveness is a general goal of managed care, the primary objectives of a quality assurance (QA) program are specifically focused on ensuring the quality, appropriateness, accessibility, and availability of care, and resolving related complaints. Minimizing expensive treatments is more related to utilization management than direct QA.
Why the other options are wrong
- B. Monitoring access and availability is a core component of quality assurance.
- C. Evaluating quality and appropriateness of care is a fundamental objective of QA.
- D. Addressing member grievances related to quality is an integral part of a QA program.
HMO Quality Assurance (Texas)
A mandatory program for Texas HMOs focused on monitoring, evaluating, and improving the quality, appropriateness, and accessibility of healthcare services.
- Monitors access and availability
- Evaluates care appropriateness
- Addresses quality-related grievances
- Distinct from pure cost containment
Memory trick: QA: Quality, Access, Apropos. Not merely about cutting the cost-o.