Managed Care Research Paper

Through the use of managed care, HMOs and PPOs are able to reduce the costs of hospitals and physicians. Managed care is a set of incentives and disincentives for physicians to limit what the HMOs and PPOs consider

The 53 RWHAP Part A recipients reported the total number of service categories funded. The services funded by recipients are divided into two categories: core medical services and supporting services. On average, 22.2 service categories are funded by recipients, including both core medical and supporting services.

The article I choose for the Unit 4 Assignment addresses how health care reform is unfinished business in United States. We still have many barriers to overcome if we to provide coverage and access to everyone who cannot afford it. Since I am earning a degree in Health Information Technology and already work in the health care industry this article is relevant to my field of study. This is a hot topic in our country today as it seems that everyone has an opinion on this subject whether for or against the Affordable Care Act. I am including my freewriting on this article below:

This writer does not believe Terri suffered a painful and agonizing death. By Michael removing her feeding tube Terri was allowed to die naturally. According to the American Journal of Managed Care, pain is not an expected part of the dying process. Additionally, federal guidelines regulate hospice and require hospice make every reasonable effort to assure patient's pain is well controlled. With proper management of medication, patients can be pain-free without hastening the dying process. Terri was admitted for hospice care so this writer is confident in stating Terri was kept comfort throughout her dying process. Also, Dr. Cheryl Arenelladoes, a writer for the American Hospice Foundation, states patients suffering from persistent vegetative

Healthcare in the United States has reached a level of complexity which has perplexed Presidents, Congressional members and private industry for over a century (Palmer, 1999). While the healthcare system has evolved over the last century, policy decisions which have attempted to effectuate changes to cost, quality and access have been

|Expanded Coverage for young adults |Employers are required to cover dependents up to|Insured population will increase as well as |

People are aware that managed care has caused patient free will to be lost in the sprint to cut price. Insurance companies in this sense control patients rather than self-monitoring or by a physician. One wants to make their choices. Managed care -whether in the form of HMOs, PPOs, etc., or limits on service- is an attempt by the payers (insurance companies, federal agencies or self-funded groups) to restrict payment for services and procedures the payers consider to be unnecessary

Managed care in the United States will constantly be changing or evolving. This is due to advances in technology, improvements made by the providers and deliverers of the services, new federal and state laws, and a shift towards a performance based system. Managed care will be delivered to the consumer in an affordable, innovative, and reliable manner with an emphasis on quality and accessibility.

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.

There are also two other less common forms of managed care. Point-of-service organizations differ from the previous two forms because they allow their clients to choose a doctor outside of the network for a slightly higher copayment (Chitty & Black, 2007). The last type of managed care involves a hospital corporation teaming with a select group of medical staff. Their teams then negotiate with managed care organizations or self-insured employers to set fees for different services (Chitty & Black, 2007).

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

In recent years, health care has been a huge topic in public debates, legislations, and even in deciding who will become the next president. There have been many acts, legislations, and debates on what the country has to do in regards to health care. According to University of Phoenix Read Me First HCS/235 (n.d.), “How health care is financed influences access to health care, how health care is delivered, the quality of health care provided, and its cost”.

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.

Health Care Administration covers a variety of different areas. Verbal communication skills are some one of the basic requirements within this major. According to the Health Care Association (HCA), to become a Non-licensed Manager you must have strong verbal communication skill which include but not limited to assisting with patient decision making and addressing issues raised by physicians, employees and patients.

It is very important for the administrator to understand the regulation and statutes in health care, it is not just because it’s their job, but it is because administrator are the ones that are in charge of managing the entire facility (depends how big is the workplace is), and responsible for the staff. Knowing the role of law that applies in health care settings and how the apply it in the facility are good characteristic of an administrator. Most of the administrators are usually the ones that work behind the scene to make sure all the activities and staff that works in the facility/clinic are following the regulation that are presented to each in everyone. They are also the ones that arranging/fixing some problems