Managed Care: How it Evolved and Its Efficiencies and Inefficiencies
Managed care has contributed to the transformation of health care delivery across the nation. While managed care originated in the United States, its delivery style has spread internationally. Managed care can be discussed in two different contexts. The first framework describes an approach to health care delivery and is described as the integration of the financing, insurance, delivery, and payment functions within an organizational setting (Shi and Singh, 2019, p. 4). The second term could refer to a physical Managed Care Organization (MCO) which could be different settings (Shi and Singh, 2019, p. 361). The Affordable Care Act (ACA) of 2010, a health care reform initiative, is enriched with managed care strategies. After reading the background information, conduct additional research and respond to the following questions.Case AssignmentWatch the following videos in preparation for this assignment:NY State of Health (2016, January 12). Health Insurance Explained [video]. https://www.youtube.com/watch?v=i9fRGwg0btkH. S. Rexburg (2016, October 19). Accreditation of health care [video]. https://www.youtube.com/watch?v=3XDs7ccTQDsUse what you learned from the videos, the module’s required readings, and your own research to answer the following questions in your paper.1. What is managed care and how did it evolve?2. Discuss the current state of managed care in the U. S. Health system. Describe two efficiencies and two inefficiencies in managed care.3. Why is it important for policy makers and health care managers to understand the intricacies of the health care delivery system?4. Briefly describe some impacts of health care reform initiatives on managed care in the U.S.Length: Submit a 3- to 4-page paper, not including the cover page and the reference list.Assignment Expectations Assessment and Grading: Your paper will be assessed based on the performance assessment rubric. You can view it under Assessments at the top of the page. Review it before you begin working on the assignment. Your work should also follow these Assignment Expectations
BHS 450 Case 2
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BHS 450 Case 2
Introduction
Reducing costs while increasing patients’ quality of care remains the primary goal of managed care. The main purpose of applying managed care in the delivery of health services is to prevent patients from seeking assistance from specialists. Research illustrates that a crisis will always ensue whenever patients seek services from specialists, yet they do not need them (Shi & Singh, 2019). For instance, by seeking the not-needed specialized assistance, such patients deprive others of the crucial resources they may direly need. Therefore, the introduction of managed care is beneficial as it aims to restrict patients to their general provider or health services, thus reducing the costs associated with it and maintaining the working environment as stable as possible (Rexburg, 2016). Although the Affordable Care Act (ACA) aims to standardize the country’s access to high-quality care by decreasing healthcare costs for both consumers and providers, research illustrates that there are supporters and opponents of the policy (Shi & Singh, 2019). Therefore, moving forward, the managed care system will help bridge this gap by improving the healthcare model as intended by the American government.
What is managed care, and how did it evolve?
Managed care refers to an established healthcare delivery system. The system comprises healthcare providers and hospitals that utilize resources with centralized oversight. The managed care model is not new because its origin dates back to the 19th century. In the past, people knew managed care as a prepaid group practice, and the earliest known health maintenance organization began in a Western clinic in Tacoma, Washington. The Western clinic offered patrons a wide range of medical services and resources. The beneficiaries were only required to pay $0.50 monthly as the clinic’s resident providers supported it. Since its introduction in Tacoma, the managed care system has continuously been applied in various ways. For example, private corporations have adopted its use. In contrast, the government has initiated programs, such as ACA and Medicaid, to maximize access to healthcare and manage the health market.
Although most healthcare organizations nowadays offer extensive services at reduced costs, research illustrates that they use a system where the general practitioner manages care and consults with specialists when needed (Folland et al., 2017). Another classification of managed care is preferred provider organizations, where patients access health care services from a network of health providers but must pay higher fees if they use the services of providers outside of the network. The two systems discussed above have an existent hybrid referred to as point-of-service plans (Folland et al., 2017). In this crossbreed, the client proceeds to utilize the services of a custodian primary care physician but can still enjoy out-of-network benefits. Patrons have to pay the penalty associated with the increased fees for out-of-network services. The presence of these managed care plans is intrinsic as it allows clients to have various options while remaining covered under a set schedule by merging healthcare and finances (Folland et al., 2017).
Discuss the current state of managed care in the U. S. Health system. Describe two efficiencies and two inefficiencies in managed care.
Like all policies, the United States healthcare system is prone to various threats, such as political, economic, social, and cultural values, technological progress, global influence, physical environment, and population characteristics. Therefore, no select agency governs the health delivery system entirely in the United States. The provision of managed care to the public occurs under poor market conditions because a client’s insurance coverage determines their access to health services. Besides, third-party insurers who act as intermediarie...