Current And Future Trends In Managed Care

Even though within the Managed care trends there have been many rapid transformations throughout the years with the HIPAA laws enforcements throughout health care facilities within the United States and Obamacare. Currently, there are challenges ahead with the healthcare reform due to the new presidency stirring up changes with health insurance and getting rid of Obamacare. Throughout the managed care trends chronic condition management have affected two-thirds of the baby boomer’s generation causing them to have chronic health conditions that them to receive medical treatment constantly with elevated health care cost. Next, a trend of having the options available for mobile health has grown tremendously by allowing many a chance to gain access

There have been many studies performed focusing on the rising costs of health care and some of the findings state that the rising cost of healthcare premiums is a worldwide problem. However, I believe they are higher in the U.S. In 2015, U.S. health care costs were $3.2 trillion. That makes healthcare one of the largest U.S. industries, equaling 17.8 % of the Gross Domestic Product (GDP) in comparison to the late 1960s; where healthcare costs were only $27 billion, or 5% of the GDP, which averaged $9,990 per person each year. The main reason for the rising cost of healthcare is a combination of government policies and lifestyles changes. Examples included lack of coverage or costly coverage, lack of available coverage for

There has been discussion to have universal healthcare system similar to Medicare as a method to have a centralized monitoring system of cost. There have also been other systems tried beginning with HMOs in the 1970s in an effort to streamline access to necessary healthcare services by employing a gatekeeper to their access at the primary care levels. With patient dissatisfaction, PPOs were tried which circumvent the necessity of referrals (Hacker, 1998). Either of these models had substantial effect on healthcare outcomes while the cost of healthcare continued to skyrocket. The US spends more than any other country on healthcare but outcomes are not better (Blackstone, 2016). In 2010, under President Obama’s leadership, Affordable Care Act was passed and one of the promising features is the formation of accountable care

Health care costs have been rising for several years. Expenditures in the United States on health care surpassed $2.3 trillion in 2008, more than three times the

“The amount people pay for health insurance increased 30 percent from 2001 to 2005, while income for the same period of time only increased 3 percent.” (Source: Robert Wood Johnson Foundation). The rising cost of healthcare is a huge problem in America today. In this paper I will analyze the different issues and causes for the increase in cost.

Given huge potentials and resources, the healthcare system in the United States stands among the best in the world; however, it has been constantly plagued with issues of cost, access, quality and distribution.1 The national health expenditure levels on per capita basis as well as the percentage of GDP has for several years remained higher than other OECD countries but has in contrast, been ranked low on significant health indicators.1,2 As part of the ongoing healthcare reform efforts, the Affordable Care Act (ACA) was passed in 2010 which led to outright and possible immense changes in healthcare.1 Accountable Care organizations (ACOs) were presented as the healthcare delivery system signature of the ACA, as a novel Medicare payment model.3

Managed care was born out of necessity. It involves plans, members, providers, and payments intertwined, one not working without the other. With managed care came rising health care costs. Utilization management and quality initiatives were introduced to help control these costs. Medicare and Medicaid were also helpful in setting standards of care which reimbursement is based on as well as providing access to health care for more people. Health care costs continue to rise but with passage of the Patient Protection and Affordable Care Act (ACA) the goal is more people will have access to affordable, quality health insurance while reducing the growth in our healthcare spending.

The passage of the Affordable Care Act (ACA) has prompted policy makers and healthcare providers to review the current system of providing services to individuals and families. The previous system of providing healthcare services was impaired by inefficient systems that had elevated costs, waste of resources, and in some cases obstructions that prohibited individuals and families in seeking care in a timely manner. The goals of the ACA is to improve the health of the nation, increase quality of healthcare services, and reduce costs of the overall system while providing health insurance options to all people across the country. The health insurance exchanges provide options for all Americans to gain access to health insurance options, but

At one point, managed care was the viewed as a resourceful tool in efforts to help assist employee, physicians and hospitals with quality health care, while controlling the cost of medical care in the United States. Over the past 30 years, managed care has been in the limelight of health insurance, as a dictator of how it will pay for medical bills. There have been many factors playing a role with managed care over the years. For example, due to the slim selection of options that are available with physicians in rural areas, and limited physicians to choose from, does this compromise the quality of care of each member or does this cut off services for members

The health care system in the United States has been growing and changing for years and will continue to do so for years to come. The one constant in the Unite States health care system is change and evolution through evaluations of those changes. If there had not been unrest with the level and provisions of care in the early 1970s Managed Care may have never been introduced. President Nixon signed legislation in 1973 termed, Health Maintenance Organization (HMO) Act of 1973. This pivotal event in the health care system allowed for a change from the fee for service model to a comprehensive range of medical or health

The U.S. Department of Health and Human Services (HHS) has established objective to meet the demands on the PPACA. Each of these objectives will show how the recommendation from the previous section align with the initiative of the ACA. Of first recommendation cover the control and lowering of health care cost. We see in objective D that the goal is to reduce the growth of healthcare cost while promoting high-value, effective care. This objective is meet through the ACA market reforms to individual and in business that ensure access to quality patient care. The law implemented reforms that gave consumers leverage when purchasing insurance. These initiative also rewarded physician that delivery high quality, efficient and well coordinated care. More over, the Federal Coordinated Health Care Office was established to improve coordination between state and federal to ensure full access to Medicare and Medicaid beneficiaries (). The Performance goal include reducing readmission rate for Medicare

One of the greatest changes in healthcare in the past ten years has been the rise of managed care, much to the displeasure of many patients and physicians alike. Managed care arose out of concern about spiraling healthcare costs and was designed to encourage physicians to give patients treatments that were cost-effective out of their own financial interests. "The consumer strategy was directed at imposing some barriers to use by levying various forms of co-insurance. The most common approaches used either deductibles (where the consumer paid the first portion of the bill a technique familiar in other types of insurance) or co-payments (where the consumer paid a portion of the bill and the insurance company the rest) or a combination of both' (Kane et al 1994). Managed care has given health insurance companies an increasingly significant voice in how treatment is administered and allocated. Managed care has proliferated in the past decade despite considerable criticism of the practice of 'nickel and diming' patients as well as the considerable bureaucratic red tape it is has generated. Also, research indicates that healthy, well-insured patients tend to over-consume care without meaningful co-pays but poorer, sicker patients can be deterred even by moderate co-payments and suffer negative health consequences (Kane et al 1994). However, managed care has not gone away and is a reality that all healthcare

The costs of health care are higher in the United States than in other countries and put a strain on the overall economy. In the United States, health care is technologically advanced but expensive. Health care costs were about $2.6 trillion dollars in 2010. For decades, the amount of money spent on health care has increased more than the overall economy has grown. Health care is paid for by government programs, private health insurance plans, and the person 's own funds.

The U.S. healthcare system has considerably transitioned from a period of traditional care to managed care to accountable care. The success of the accountable care regime would largely depend on the ability of ACOs to deliver on promises of cost reduction and quality improvement. And if it does, to sustain the feat. Given annual changes and additions to its forms and measures, ACOs are still in formation and at this stage, it may be untimely to tell if they are indeed the unobtanium of healthcare. Its aim of managing the basic elements of care – cost and quality all in one piece definitely comes with challenges which have been discussed. Nevertheless, it would take time for the health system to completely adjust to the period of accountable

Managed care was established in order to manage health care cost, utilization, and quality (Kongstvedt, 2015). In managed care, health insurance is provided through HMO, PPO, and other types of managed care. It has the potential to reduced health care spending and improved the quality of care. However, despite of its success in improving the quality of care through preventive health care services, chronic disease management program, and so forth, many physicians are reluctant to be part of the managed care environment. Some of the reasons are the impact of managed care to physician’s income and autonomy. Under managed care, insurers have decreased the fees paid to physicians. There are different ways how managed care organizations control costs. One of this is through selective contracting with health care providers and hospitals to lower costs. In selective contracting, health care providers agreed to accept lower prices in exchanged for guaranteed volume of patients under managed care plan (Culyer, 2014). This paper will discuss more issues and trends in Managed Care Organizations such as the rise of Medicaid Managed Care spending, the new Medicaid Managed care Rule, and the collaboration of Managed Care Organizations and Accountable Care Organizations to reduce health care spending and improve efficiency of care.