The Concept of Managed Healthcare

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

rising health care costs. Managed care can be defined a system of delivering health services in

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

One of the benefits of the Managed Care is the lower costs. This help health cost down without sacrificing quality and can accomplished by contracting health care providers and able to refer the enrollee members to available of services and procedures at a discount rate. Another benefit is associated with the Managed Care is network of health care providers that are readily available to them. These health professionals and facilities have gone through accreditation process and their credentials and experiences carefully analyzed and essential capacity to serve members with quality care. The disadvantage of the Managed Care for some members is the rigidity of rules applies in the choice of health care provider; for example like HMO. Some enrollees

Kleiner, B. H. (2012) Gives insight into conducted research to show how research of managed care has increasingly become a leading development in regards to the finances in managed

Managed care has turned into the name for a change in the way health care is organized and financed in the US. Now a day the health care system is not just difficult, it is essentially unique in relation to what it used to be. The progressions are numerous and speak to the real moves required in moving from an indemnity plan, founded fundamentally on what the patient needed, toward a managed care system. The American human service has experienced radical changes inside two eras and keeps on developing. The federal legislation that I have chosen that most significantly influenced the growth of managed care from my point of view are the HMO Act of 1973 and HIPAA.

Managed Care is a complex healthcare system in which physicians, hospitals, and other healthcare professionals organize in an interrelated system of people and facilities that communicate with one another and work together as a unit, commonly referred to as a network. This network coordinates and arranges healthcare services and benefits for a specific group of individuals, referred as enrollees, for the purpose of managing cost, quality, and acess to healthcare. Managed care program may be provided in a variety of settings, such as Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO). Managed Care Organizations (MCOs) performs three functions: (1) set up the contracts and organization of the healthcare providers who furnish medical care to the enrollees, (2) establish the list of covered benefits tied to managed care rules, and (3) oversee the healthcare they provide. Managed care greatly influenced the practice of medicine and that the enactment of the Affordable Care Act greatly affects managed healthcare planss (Beik, 2014). This paper will examine the future of managed healthcare delivery system under the Affordable Care Act provision to expand Medicaid program.

Those of us who have served in the Military a very familiar with managed care, we may not totally understand the concept of managed cared but are recipients of it daily. Unless there is a heated political debate about health care reform we usually don’t worry about health care reform. Health care cost is not something that we worry about; after all the government takes care of all our medical needs, even when we are seen out on the economy. The only time we might the troubles of health cost might visit our door steps occur when family members decided to see an out of network provider, we are them held accountable for paying medical bills. What I failed to realize during my time on active duty, Tricare is just another form of a managed care program. In this essay we will explore the history of managed care and Health Maintenance Organizations (HMOs). Additional, we’ll take a look at how managed came about, and the future of managed care and health care reform in the U.S.

I believe that that managed care impacted the historical evolution of health care. When managed care was developed in the United States the main purpose was to improve medical care outcomes as well as efficiency. Westert, G. P., “During the second half of the twentieth century, managed care developed in the United States as a mechanism for constraining the growth of health care costs by controlling the delivery system” (2005). The federal government decided to offer managed care options through Medicare because of the growing expenses that the elderly have to through Medicare. Westert, “Reductions in health care utilization brought about by managed care in the western United States have been adopted in other areas of the nation and the world” (2005).

Health care has grown and evolved over the centuries from haphazard treatment based on tradition and superstition that often times did more harm than good, to a system that is able to preserve life in situations where life was previously believed to be unsustainable as recently as just 50 years ago. The concept of managed health care began over 100 years ago as a means by which medical care could be provided to injured workers, but has undergone major changes to evolve into the health care delivery system that we are familiar today.

Fundamental changes, one of which is managed care, have been introduced to the healthcare system to improve people’s health and deal with challenges of increased healthcare cost and uncontrolled healthcare utilizations (Steele & Merrick and 2013Shi & Singh, 2015).

The Managed Care System was introduced to control the cost for health services provided to individuals. Managed care controlled who the consumer would seek health services from, as well as the cost of the service provided. MCO’s became deep-seated when President Nixon signed the Health Maintenance Organization (HMO) Act in 1973. The first type of managed care used were HMO’s and the purpose was to keep healthcare costs within limits. Physicians of course were against the Act. This would now control the fees that the physician would charge for the services they provide to the individual. As Managed Care evolved and increased in the amount of managed care plans that became available over the years. Physicians preferred guaranteed income as oppose

Managed care is a health insurance system designed to reduce the cost of health care while providing quality services to gain maximal outcomes (“Managed Care,” n.d.). According to Medicaid.gov (n.d.), under the managed care system, members receive care at reduced costs due to contracted agreements between state Medicare agencies and health care providers. While States are progressively using managed care for Medicaid beneficiaries, the available evidence concerning its effect on health care outcomes is mixed, with little consistent evidence to support its efficacy (Caswell & Long, 2015).

Managed health care has come a long way in positive and negative ways to change health care organizations for the better. Every aspect of managed health care involves the time periods of early, middle and mature years of policies, growth, and stability for organizations. Many inventions and laws were started from the beginning of health care to become beneficial today for patients. Managed care provided in the early period times have been tremendously useful today as technology, medical devices, social, and economic factors made managed care grow exceedingly well. There are infinite benefits to these early period managed care services and professions for the better good of society. Examining the elements from the early period of managed

While doing some research on ‘’managed care’’ I’ve learned it is a health care system where patients agree to visit only certain doctors and hospitals, and where the cost of treatment is monitored by a managing company to put it simply your medical services will be provided but only if you visit agreed upon hospitals and doctors know where these services are provided is based upon the medical necessity of the needed service and what that mean is whether or not it meets the reasonable, necessary, and or appropriate clinical standards or as it is at times referred to as a utilization management review and in my opinion it seems like a good system for health care you would still be receiving your medical services they would just be for certain