Quality can and should be measured in different ways. Quality can signify a clinical aspect - such as the rate of immunization or the use of prenatal care. On the other hand, it can also address administrative issues such as how a member is treated on the phone and in person by Health Plan staff. Health Plans carry out a number of different quality assurance exercises.
Plans document their performance in a range of quality areas.
There is an assumption that since many Health Plan providers are prepaid for services, the interest in treating patients would be low. To prevent such abuse, Health Plans monitor its doctors to be sure that preventive care and referral services are being used according to the best medical practice and regulatory standards. Health Plans are required to sustain an additional level of quality assurance by federal regulation and state law. These extra measures are not provided to those in traditional insurance, because those insurers are not required by law to monitor the quality of care provided by your doctor. Without a close relationship with doctors, a traditional insurance plan cannot monitor the quality of care the way Health Plans can.