Managed Care

Managed care dominates health care in the United States. It is any health care delivery system that combines the functions of health insurance and the actual delivery of care, where costs and utilization of services are controlled by methods such as gatekeeping, case management, and utilization review. Different types of managed care plans came into development by three major factors. These factors include choice of providers, different ways of arranging the delivery of services, and payment and risk sharing. Types of managed care organizations include Health Maintenance Organizations (HMOs) which consist of five common models that differ according to how the HMO is related to the participating physicians, Preferred Provider Organizations

of the patient with controlling the costs of care, the issue of the uninsured began to grow. The concept of some sort of governmentally funded universal health care for all began over a century ago, however, never successfully implemented. From a historical viewpoint, individuals obtained health insurance by purchasing their own policy, as a benefit of employment, or through governmentally funded programs that required certain eligibility criteria be met in order to be eligible. If a person did not qualify for one of these types of health insurance, they generally were left without health insurance coverage.

Health care in America is a serious issue as it involves families that are unable to receive accessible, affordable and quality medical treatment. Middle class or impoverished families are unable to receive the benefits of health care due to low income levels and a volatile economy. Politicians discuss the reformation of the health care system, but people who are uninsured suffer the consequences of a system that overlooks middle class families in favor of wealthy families, a dominant issue for conflict theorists. Some argue that the health care system is not in need of reform and state that

In this country there are numerous concerns about health care economics. Several factors contribute to the increase of health care costs. One area of concern is the impact of managed care on health care finances. Managed care has been around since the early 1970s. The definition of managed care is a set of contractual and management methods implemented to manage the financing and delivery of health care services. Initial implementation of managed care was for health care cost saving (Getzen & Moore, 2007, p. 203, para. 1). Though Managed care initially addressed several health care finance issues, there are still problems with the current

To attract Medicare patients, hospital must be contracted with Medicare. Hospital must also be contracted with private health insurance companies that provide Medicare Part A or Part B benefits. As per Kaiser Family Foundation, there are more than 55.5 million Medicare beneficiaries in the U.S. and Texas has more than 3 million. Hospital should have regular contact with senior citizens and can be made attractive to Medicare patients by offering sessions about healthy life style choices. Also offer regular disease management sessions, exercise group and organize social activities such as trips to mall, museums. Seniors should also be encouraged to take tour of the hospital.

On March 23, 2010, President Barack Obama signed the Affordable Healthcare Act into law. It had been estimated that 30 million people would sign up for the new healthcare act. As of April 15, 2015 the actual number of people that have signed up is 11,776,046 which is a far cry from what was predicted. Within the healthcare system all across the United States things are changing. How will the Affordable Healthcare Act impact the healthcare system within the United States? This paper will address what the Affordable Healthcare Act is first and then

On March 23rd of 2010 one of the most highly controversial bills in American history, the Patient Protection and Affordable Care Act (PPACA), better known as the Affordable Care Act (ACA) was passed into law. The Affordable Care Act attempts to reform the healthcare system by providing more Americans with affordable quality health insurance while curbing the growth in healthcare spending in the U.S. The reforms include rights and protections, taxes, tax breaks, rules for insurance companies, education, funding, spending, and the creation of committees to promote prevention, payment reforms, and more. Four years since being passed has the Affordable Care Act begun to make healthcare more affordable to Americans? When it comes to the affordability of health care In the United States, health care has always been a private for-profit industry. The main purpose of the ACA is to make insurance more affordable and expand coverage to uninsured Americans by enacting a number of provisions. This research paper will explore some of these provisions, document their details and decide whether are not they are truly helping make health care more affordable.

There had been previous research that displayed that managed care contracting added to physician dissatisfaction and also their administrative expense. It was determined that physicians had the option to choose to contract and also the number of contracts to have. The results of this survey suggested that physicians who contract with more health plans worked more hours and earned more money.

The concept generates images of large healthcare entities managing the administrative protocols of prior authorization or denials to the actual delivery of care through a facility or network of healthcare providers. Hacker and Marmor (1999) described several meanings of the term managed care with the most applicable to the menagerie of forms managed care can take being a combination of the financing and delivery of healthcare services. While this particular study is dated, the authors contend any managed care structure features administrative oversight, patient steerage to a particular provider entity or network and the amount of risk-sharing whether at an individual or group level. These features continue to be true today as organizations explore the benefits offered to employees through managed care structures such as preferred provider organizations, clinically integrated networks, and accountable care organizations. As a healthcare provider, the goal is to provide access to healthcare which is affordable, offers access to providers of choice and engages with providers who provide the highest quality

What is managed care? According to the Oxford English Dictionary, managed care is “a system of health care in which patients agree to visit only certain doctors and hospitals, and in which the cost of treatment is monitored by a managing company.” Managed care is a variety of techniques designed to essentially reduce the cost of providing health benefits and advance the quality of care. In the United States alone, there are various managed care programs, that span from less restrictive to more restrictive. As recently stated in the National Institutes of Health, the future of managed care is uncertain. It is enthralling to note that in spite of the advances in the health care systems, such as our hospital’s ability to provide patients

Beginning January 1st, 2014, the health care insurance marketplace, or an online price comparison website will be open for Americans to shop for the most affordable

Managed care and its competition is being viewed to solve their issue on the struggle to control

Managed care is the most dominant healthcare delivery system in the United States and available to most Americans. Employers and government are the primary financiers of managed care. The managed care sector includes approximately

HMOs multiplied rapidly with the new federal giveaways. Managed care, now including PPOs, mushroomed. Employers initially perceived managed care plans as cheaper than traditional fee-for-service insurance. Gradually, they stopped offering a choice of health plans, making individual policies more expensive. HMOs' penetration of the industry had been subsidized into existence. Government had instituted managed care. Today, while overall quality of patient care remains the best in the world, doctors practice medicine in an increasingly intricate web of rationing and regulations: Physicians are stripped of professional autonomy. As patients wander the maze of managed bureaucracy, costs rise and quality deteriorates. Every American dependent on a third party for health coverage is a potential victim of managed care. And state sponsored management of medicine

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.