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Each adverse event is chosen because it is thought to have a high probability of indicating poor quality and therefore warrants further review and possible intervention.
HMOs seeking federally qualified status meet certain standards of organizational structure, benefit levels, and financial stability, and that they have an organized medical structure capable of providing clinical services that, in turn, are subjected to quality review.
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Although the goals of risk management and quality assurance are not entirely coincident, their integration is intended to maximize the use of limited resources, eliminate duplicative data collection, and help in devising solutions to problems.
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