Evolution Of Managed Care And The Forces That Have Driven Its Evolution

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Describe the evolution of managed care and the forces that have driven its evolution. Managed care and its competition is being viewed to solve their issue on the struggle to control rising health care costs. Managed care can be defined a system of delivering health services in which care is delivered by a specified network of providers who agree to comply with the care approaches established through a case management process. Managed care has a one hundred years of history in the United States, and it gained national recognition around mid-1970s. The health maintenance organizations (HMOs) are managed care organizations. There are two categories of MCOs are, preferred provider organizations (PPOs) and point of service plans (POS). There are over half of Americans with health insurance are enrolled in managed care plans. Currently the debate in the United States is in regard to the quality of care provided by MCOs and traditional fee-for-service plans. Another major issue with managed care is the use of gag clauses in contracts amongst the MCOs and their providers. These clauses limit providers from being more informative to patients about the alternative treatments or the details of reimbursements for providers. The U.S. health care reform failed in 1994, and it caused a more focused turn to the marketplace to provide the stimulus for reducing costs. A few new trends are rising as managed care enters its second generation: dual- and triple-option plans with

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