Evolution of Managed Care

1511 Words Nov 10th, 2010 7 Pages
Evolution of Managed Care HCS/235

Evolution of Managed Care Managed care is a type of system that was formed to help control the costs and quality to health care services; this will give access to services to specific groups of covered patients. The system was created to help the patients (customers) to receive services without having the full financial burden (University of Washington, 1998). The managed care services’ goal is to be able to help individuals and their families by providing health care services that is affordable. This type of managed care will help employees or individuals by requiring a set fee to be paid to the physician for visits, a co-pay and monthly premium to be paid to the insurance company. This will
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The managed care programs is a staff model HMO, using the model there is an individual practice associations (IPAs) and the network-model HMO’s (Davis, Collins, & Morris, 2006). The IPA model and the HMO service will allow a physician to set a fee-for-service for patients and be able to contract with other plans to provide services to the people enrolled in their offices (Davis, Collins, &Morris, 2006). The IPA providers will be reimbursed for their services a various number of ways from fee-schedules to captivated payments (Davis, Collins, & Morris, 2006). The network-model HMO plan will work with multispecialty practices they have no connections with the HMO and then are reimbursed by capitation and fixed monthly payments (Davis, Collins, & Morris, 2006). There was an expansion in 1973 on the industry to better control the cost and provide more comprehensive coverage (Davis, Collins, & Morris, 2006). From 1973 to 1982 grants and loans were provided to develop HMO’s. They required employees of large corporations to extend the coverage to all the employees if in the areas that coverage was available. The expansion of the managed care plans soon multiplied into new forms, since few precautionary measures were taken to measure and record the data of the growing success, it caused three major changes in the last couple of years. Changes in Managed Care “In the past

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