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Practice Guidelines: Managed Care Plans Customize Guidelines to Meet Local Interests

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Report Type Reports and Testimonies
Report Date May 30, 1996
Report No. HEHS-96-95
Subject
Summary:

Inappropriate use of medical services can be costly and raise quality of care concerns. For example, a 1988 study found that 14 percent of bypass surgeries were performed inappropriately. To narrow the gap between current and optimal practice, some federal agencies and other groups develop clinical practice guidelines on the best practices for effective and appropriate care. Managed care plans, which employ various techniques intended to reduce inappropriate care, are likely sites of guideline use. This report discusses (1) the purposes clinical practice guidelines serve and (2) how health plans make use of already published guidelines developed by federal agencies and other groups.

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