Essay on Different Types of Managed Care

“An Integrated Physician Model is the result of a series of partnership between hospitals and physician develop overtime” (Harrison, 2016). Primarily, it is a joint venture that has become many joint ventures. In addition, all of this joint ventures are connected through congruent goals, and that is to provide different level of care to all the patients. Integrated physician model also organizing themselves to improve the cost and quality by operating under a clinical guideline. This could include acute care hospital, home care, nursing homes, affiliated medical group, primary care clinics, employed physician and any independent medical groups.

The United States has a unique system of healthcare delivery, it is complex and massive. Twenty-five years ago; American citizens had guaranteed insurance, meaning the patient could see any physician and the insurance companies and patients would share the cost. But today, 187.4 million Americans have private health insurance coverage (Medicaid, 2014). The subsystems of American health care delivery are Managed care, military, vulnerable populations and integrated delivery

In today’s time, the hallmark of the US health industry is to form integrated delivery systems. An integrated health delivery system is an arrangement of health professionals and health care facilities that provide health services within a continuous organization of delivery. These systems will allow the purchaser and consumer of health care service to receive all the needed services within a all-in-one delivery system that would facilitate the needed access to the appropriate level of care at the appropriate time (Professional Issues). I.D.S presumably will also provide higher quality services and more patient centric care at relatively lower costs (Effects of Integrated Delivery Systems on Cost and Quality). To best understand integrated delivery systems (IDS), it is helpful to contrast the IDS model with health service delivery under the traditional fee-for-service (FFS) arrangement.

Preferred provider organizations offer flexibility in benefit design and allow patients flexibility to choose from a list of in-network providers for their care. Care provided in-network typically is discounted with out of network services resulting in higher out of pocket expenses to the patient (Hirth, Grazier, Chernew and Okeke, 2007). Clinically integrated networks are a more recently developed managed care structure. In this model, independent practitioners form a virtual network as a means of increasing capacity for contracting with payers of healthcare whether commercial insurance or for self-insured organizations. Physicians recognize advantages to collaborative contracting and the increase in coordinating care of patients through the network (Kaplan and Guest, 2012). Commercial insurance companies are looking to clinically integrated networks as another mechanism to control the costs of healthcare delivery. Accountable care organizations, as with clinically integrated networks, are fairly recent phenomenon with similar but more formalized characteristics. An accountable care organization is a structured network of healthcare entities which have united and are responsible for the health of an identified population. The accountable care organization shares the risk of meeting the health needs of

William Shakespeare wrote a famous piece called “The Taming of the Shrew” in the late 16th century. In 1999, a modern version of Shakespeare's piece was created into a film called “10 Things I hate About You”. They are obviously both similar due to the fact that “10 Things I Hate About You” was a remake of the original, but they are not completely the same. The modern film version was changed to suit a different audience of the time period and contained more up-to-date features.

Managed care in the United States will constantly be changing or evolving. This is due to advances in technology, improvements made by the providers and deliverers of the services, new federal and state laws, and a shift towards a performance based system. Managed care will be delivered to the consumer in an affordable, innovative, and reliable manner with an emphasis on quality and accessibility.

Each state has their own policies for Medicaid eligibility, services and payments. Medicaid plans have three eligibility groups such as categorically needy, medically needy and special groups. Children's Health Insurance Program (CHIP) is a program that offers health insurance coverage for uninsured children under Medicaid. If Medicaid does not cover a service, the patient may be billed if the following conditions have been met such as the physician informed the patient before the service was performed that the procedure was not covered by Medicaid and if the patient has signed an Advance beneficiary Notice form. However, there are also conditions where the patient cannot be billed if necessary preauthorization was not obtained or service

Bohmer, R., & Knoop, C. I. (2007). The challenges facing the U.S. healthcare delivery system. Harvard Business School, Article 9-606-096.

Knickman, J. R., & Kovner, A. R. (Eds.). (2015). Health care delivery in the united states (11th ed.). New York, NY: Springer Publishing.

The Affordable Care Act (ACA) strives to improve the quality of the lives of Americans. The most current healthcare policy that endorses the ACA, is the ObamaCare initiative that has received a fair share of both support and criticism. (Hwang, et al. 2013) talks about the “Effects of the integrated delivery system on cost and quality”. According to the authors, most people criticize the American healthcare system because of its complexity, high cost and excessive fragmentation. The same scholars confirm however that the fragmentation and the provision of various services, benefit different people that require healthcare attention. The article focuses on several advantages of the integrated healthcare delivery systems (IDSs) in the United States. Furthermore, the scholars identify existing gaps, which include the various arguments of current health policy experts that have endeavored to discuss health policy issues in America. Americans can also access health care services through virtual technologies, which allow them to have different electronic health record databases. (Hwang, et al. 2013) uses relevant materials from peer reviewed and non-peer reviewed articles to describe the fluctuating nature of healthcare service delivery in America. Conclusively, the authors agree that the virtual systems create room for accountability, academic research in healthcare and efficient service delivery.

The types of managed care are differentiated by definition, operation, structure, and information needs. `HMOs were the most common type of MCO until commercial insurance companies developed PPOs to compete with HMOs' (Douglas, 2003, p.331). `HMOs are business entities that either arrange for or provide health services to an enrolled population after prepayment of a fixed sum of money, called a premium' (Peden, 1998, p.78). There are three characteristics that an HMO must have. The first is a health care financing and delivery system that provides services for members in a particular geographic area. Second, is ensured access to a complete range of health care services, health maintenance, treatment, and routine checkups. Last, health care must be obtained from voluntary personnel that participate in the HMO. The five HMO models related to the participating physicians are the Staff

The United States healthcare delivery system is a uniquely developed system that involves various features, components, and services. The US delivery system is massive, with total employment in various healthcare settings of qualified medical professionals that provide key functions to delivering quality healthcare. The market-oriented economy in the United States attracts a variety of private entrepreneurs driven by the pursuit of profits obtained by carrying out the key functions of healthcare delivery (Shi et al. 2015).

According to the Marriam-Webster Dictionary, theme is defined as "a subject or topic of discourse or of artistic representation." Throughout human history stories have evolved, and so have the themes behind them. Whether it is through the use of an adage, proverb, or folk tale the meaning behind one is something we all can think of. Plays and other artworks are no different. When reading the literally artwork titled Macbeth by Shakespeare, it is filled with themes and concepts that can be translated to normal everyday life.

The best health care systems in the world offer integrated care. Systems like the Mayo Clinic and Geisinger Health System own hospitals and labs and employ all the physicians and nurses a patient is likely to see, so they can easily integrate a patient’s care. In contrast, patients in North Carolina and throughout America typically obtain their care from a variety of independent providers. Health care expenses are paid by a variety of sources including private insurers, employers, the government and patients themselves. But unlike any other state, or even any large geographic area, North Carolina has the capacity to create a “virtually” integrated system, one that can provide the same integrated care but across an entire state. When patients’ transition between providers and health care settings, the result is often poor health outcomes, medical errors and costly duplication of tests and procedures. Through partnerships with other organizations and providers, NCHQA is seeking ways to better coordinate care and address systemic problems that cause dangerous and costly gaps in care. (NCHQA, 2014)

Imagine being asked to state your last words. What would they be? The execution of a human being is irreversible and should not be allowed anywhere. The death penalty is a crime in itself and should not be used as a form of punishment.