write an article on healthcare financial and clinical performance

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The essay aims to address a two-fold objective to wit: (1) to select metrics for financial and clinical performance in a healthcare organization. and (2) to discuss the rationale in choosing the metrics according to administrator’s point of view.


Metrics are used to evaluate care and accurately measure performance of an organization. Selecting an appropriate metrics is critical to the provision of health as it requires multitude of skills, experiences, and technologies. Metrics to be used should project a balance between the organization’s financial and clinical gains. In this case, the Health Plan Employer Data and Information Set (HEDIS) by the National Committee on Quality Assurance (NCQA) could be the best metrics to quantify managed care plan performance of the healthcare institution.

On the administrator’s perspective, HEDIS is the appropriate metrics to use in a healthcare organization because of the following reasons: feasibility and SMART (Specific, Measurable, Attainable, Realistic, and Time-bound) goal. HEDIS is a feasible metrics because it has become the standard metrics among employers and selected government institutions to measure and evaluate standards of care. thus, HEDIS is also is also realistic as it actually exists (American College of Medical Quality, 2005, 91). To quantify managed care plan performances, HEDIS has 60 metrics which are specifically divided into 7 categories, namely: effectiveness of care, access or availability of care, member satisfaction, use of services, cost of care, informed health care choices, and health plan descriptive information (American College of Medical Quality, 2005, 91). In addition, these categories can provide a measurable and attainable methodology because of its collection and calculation processes known as the HEDIS Compliance Unit. It is responsible for auditing standards to the activities that already occur in an organization. Lastly, HEDIS is time-bound metrics as it is an integral part of NCQA accreditation that must be participated in two audits per year, preapproved 12 hours of continuing education credits, and attended Auditor Update Conference annually to successfully renew accreditation every two years. Without this accreditation in a span of two years, financial and quality growth based on standards is not feasible.

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