Nursing-Case Study

You are the newly appointed director of quality management at a medium-sized MCO that was originally a group model but now have about half of its members cared for by physicians in a network model arrangement. NCQA has recently adopted and promulgated a new set of measures for quality of care of diabetics and you know that the results will be publicized, with customers encouraged to use them to choose plans. Much of the information needed is available in your administrative data a set, which includes frequency of visits, laboratory tests, etc. You note with both interest and concern that the performance of the network physicians is nowhere near as good as that of the large group practice that is the out-growth of your old staff model arrangements. You are also very aware that patients must be active partners if your plan is going to do well on these measures, since so many of the events are ones in which patients must choose to receive care.
1. What steps would you take to improve quality in this area?
2. Should you use financial incentives or other means with the doctors?
3. What will you do with respect to patients known to be diabetic?
4. Is there any use you could make of the difference in baseline performance between the two sets of doctors?