Managed Care Philosophy and Initiatives Directed at Prevention and Health Maintenance. the Nature of the Problem of Vaccinations and Access to Vaccines Relative to Prevention and Health Maintenance. the Steps Taken to

Implementing immunizations into the clinics can be challenging for the facility and the staff. There are several methods that have been implemented to monitor the methods used by the staff to give the immunizations to the patients in the clinics. There have been several obstacles and challenges that the staff and leaders have faced. As with any changes that take place in patient care within an organization methods must be set up to monitor those changes. Changes promote challenges not just to staff leaders but the organization as a whole. Communication with any changes can be challenging for

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

The HMO’s stress wellness and preventive care, therefore its focus is more on health maintenance rather than just the treatment itself. Because of this, HMO’s offer much richer benefits than the traditional plans. HMO’s have little to no upfront costs in an effort to encourage maintenance, while comprehensive and major medical plans have up-front cost sharing so as to discourage over utilization.

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

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

Health care cost has risen dramatically in the last decade. Health care plans have been forced to look at the quality of health care given by the providers so they can implement certain strategies to help reduce heath care costs. Managed Care describes a group of strategies that is looking to reducing the costs of health care for health insurance companies. (Kongstvedt 2007)

Seasonal influenza is a major cause of mortality and morbidity in the industrialized world. The United States alone averages more than 23,000 influenza-associated deaths annually (Cortes-Penfield, 2014). Everyone is given the option to receive the flu vaccination each year. The vaccine is offered in health care facilities, clinics, and pharmacies around

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.

Managed care has been adopted into the government funded care organizations. Medicare managed care plans provide all coverage themselves, including basic Medicare coverage. Managed care plans cover above and beyond the basic benefits of Medicare, the size of premiums and copayments, and the decisions about paying for treatment are controlled by the managed care plan. The basic premise of managed care is that the member/patient agrees to receive care from only a specific doctors and hospitals, in exchange for reduced healthcare costs. Medicare, like other insurance companies offer plans that give Medicare beneficiaries more choices in coverage, like HMO or PPO. Managed care has been used since the mid 1990’s in order to provide healthcare to beneficiaries with serious or life long illnesses. Today, managed care has become a way for states to provide quality care to both Medicaid and Medicare patients.

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

The Situation/Challenge: According to the Centers for Disease Control and Prevention (CDC), the number of influenza (flu)-associated deaths in the United States ranges from a low of about 3,000 to a high of about 49,000, annually (CDC, 2010). Vulnerable populations—those with a compromised immune system, elderly, very young children, and critically ill—are especially susceptible to the influenza. (Poland, 2005). Pre-exposure vaccination is the most effective method of preventing influenza and influenza-related morbidity and mortality (Poland, 2005). However, flu vaccination is frequently contra-indicated for the vulnerable

Managed care is a system of healthcare delivery that seeks to achieve efficiency by interpreting the basic functions of healthcare delivery. It employs mechanisms to control (manage) utilization of medical services and determines the price at which the services are purchased and how much the providers get paid.

In other to manage or curtail the ever rising healthcare cost in America, Managed Care was formed. The National Library of Medicine, defines managed care as programs or organizations “intended to reduce unnecessary health care costs

What is Managed care? Managed care is a health care system which provides a person