Managed Care Essay

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

One difficulty of using Critical Path Analysis is that unless critical activities are identified and supervised closely, there’ll be delays to the whole project. Critical path analysis puts pressure on mangers to manage effectively and meet deadlines. If, for example, Balfour Beatty was unable to get hold of a particular piece of equipment when needed, the whole project could be delayed by the amount of time that it takes to get the equipment. This means that there will be many employees being paid with no output and the whole project is delayed with doesn’t usually bode well with the customer.

The Case Management program is offered by Kaiser Permanente to support members with complex medical, psychosocial, and care management essentials. This specialized service is provided by case managers. The case managers are either Registered Nurses who are certified in case management or qualified Social Workers. Case managers provide necessary information and education to promote understanding, reduce the chance of possible complications, and facilitate effective and proper delivery of care and services.

complex, but costly problems that require a lot of services from multiple providers over a

The reason for this essay is to reflect on a critical incident experience during my six week placement as a student nurse on an orthopedic ward. To explore an event as a critical incident is a value judgment, and the basis of that judgment is the significance attached to the meaning of the incident. Critical incidents are created or produced by the way we look at a situation. Tripp (1993)

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

This paper examines the benefits and issues with managed care. The benefits include patients receiving preventative care, lower premiums, lower costs of prescriptions, fewer, unnecessary procedures, and less paper work. Some issues with managed care include limitation on doctors that patients can choose from, restricted coverage, the possibility of under treatment, and compromised privacy. Managed care effects nursing by causing significantly few jobs for registered nurses, more opportunities in non-acute health care settings, and more use of advanced practice nursing.

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 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.

Care Matters LLC does not have an overall feedback loop with which it gathers information regarding efficacy. Most of the clients the agency works with are motor vehicle accident survivors who need extensive medical treatment. They are entitled by Michigan No Fault Insurance to a case manager to assist them with coordinating their medical care (Sinas, 2011). The case managers work with many different doctors, insurance companies, and claims adjusters. As such, most of their feedback takes place within outside arenas.

Managed Care organizations commonly known as MCOs basically are healthcare delivery systems in the United States which are organized to help in managing costs, value of the healthcare provided and utilization. Medicaid managed care on the same note provides for the efficient and effective delivery of Medicare health benefits as well as other essential health services through special arrangements such as contractual arrangements between the different state Medicare and Medicaid agencies and Managed Care organizations (Bechtel & Ness, 2010).

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

The first stage of this framework is coming to know the client, which requires the nurse to understand that the personal meaning of health and healing is individualized and the context of this area is highly subjective. Gillespie and Paterson (2009) state that “clinical decision-making processes are triggered by recognition of a cue from a patient” (p. 167). In the case of this patient, the decision was based off a cue; a change

Critical Path: The sequence of activities that represents the longest path through a project, which determines the shortest possible duration.

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