...The brain child of managed care was adopted in the 1973 to counter the high cost of healthcare provisions. The sole purpose of managed care was to provide effective and quality medical care to patients at reduced cost. It entailed choosing a doctor that would have been responsible in providing the medical facilities to patients with minimal charges since the companies providing such services had a contract with the organization. It was first targeted to provide medication to the timber workers, the miners and the residents residing in the rural who were unable to get affordable healthcare. The managed care has then been consumed and accepted by the American citizen as well by the providers. It is a common practice that has been promoted across...
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...management such as traditional medical groups, has been unsuccessful. If the managed care organizations are to regain their mastery over the health care system, such network models as independent practice associations ought to evolve into stronger medical group institutions that not only accept risk but which can also assume the financial as well as the clinical accountability for administering and managing the care of the population to which they provide their services (Kongstvedt, 2012). The following is a checklist that will be utilized as a tool when organizations review the UMUC Medical Center's Managed Care Contracts • What are the product lines of the MCO? • What medical services are covered by the contract? Include any service...
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...health care coverage and services. Within the past thirty to forty years, the scope and cost of health care coverage and services has drastically changed, altering the manner in which health care was previously managed. There are several factors that have affected the cost of health care coverage over the course of the past two to three decades. One of these factors is the introduction and rapidly increasing enrollment in managed health care insurance plans. Managed care health insurance plans can, in most cases, help to alleviate the rising costs of effective medical coverage. Another important factor that has affected health care costs is the invention and implementation of new medical technologies. As prominent researchers and economic analysts have discovered, there is a distinct and direct correlat! ion between advancing medical technologies and rising health care costs. Medical innovation has been proven time and again to be an important determinant of health care cost growth. It would appear that managed care health insurance plans, which attempt to lower health care costs, and highly expensive new medical innovations and procedures are at cross purposes, pulling against one another in very different directions. Market-level comparisons have found the cost growth of health care in markets with greater managed care penetration to be generally slower than that of non-managed care health insurance markets. However, managed care...
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...Course Project Anise Hutcherson Approaches to Disease Management in Managed Care DeVry University `12/11/15 Table of Contents 1. Introduction…………………………………………………………….. Page 3 2. Background…………………………………………………………….. Page 4 3. The Challenges and Problems Associated with Disease Management…….. Page 6 4. Review of the Research and Literature…………………………………… Page 8 5. Challenges/Problems Analysis with Disease Management……………….... Page 9 6. Recommend Solutions of Improvements in Disease Management…………..Page 10 7. Implementation of Solutions in Disease Management in Managed Care Industry..Page 11 8. Justification………………………………………………………………… Page 12 9. Summary and Conclusion…………………………………………………...Page 14 10. Works Cited-References………………………………………………….. Page 16 Introduction It is very well known how most physicians or healthcare facilities and organizations handle diseases in our society in my opinion. Managed care for diseases are mostly not focused on, it is for large populations. But typically physicians do try to focus on individuals however once you throw MCO in the mix it becomes similar to a farmer caring for cattle which I hate to say. And I am very much passionate about this subject because of my experience in the very arena. Before I had a stable job with wonderful health insurance, I relied on government paid insurance for a minute and during that time I was diagnosed with Lupus which is a autoimmune disease with no cure. However...
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...how? 5 Bibliography 7 Appendix 8 Executive Summary Hospital are required to bill for individual items or services provided to a patient. Patients admitted to hospitals are charged for their room, supplies, drugs, labs, x-rays, operating room time and other care. It is important to know that hospitals submit a bill to the insurance company for all the services provided to the patient and the payor determines the amount owed to the hospital based upon the insurance company’s contract with the hospital for specific services [ (Henry Ford Health) ]. Introduction The purpose of this case study is to understand the relationship between hospital charges for certain physicians and insurance carriers. Cost finding and cost analysis are the techniques of allocating data that we were provided as part of the case study. The information that we are going to use to analyze cost between Commercial Care and Manage Care insurance includes: * DAYS the number of days the patient spent in the hospital. * CHRGS is the total expenses charged to that patient. * PHYS is a code identifying the physician. * PAYOR indicates the type of insurance the patient carried. The fundamental items for this study focus on financial data related to normal...
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...markets in health care can offer patients greater quality, more options, and lower costs. The Federal Employees Health Benefits Program and Medicare Part D serve as two illustrative examples of competition in health care today. Proper reforms to add further competition to the health care industry would be quite significant and would further America’s position as the world’s leader in health care for years to come. KEY POINTS 1. The body of peer-reviewed academic literature suggests that health care can and should operate like a traditional market. 2. Market-oriented reforms have the potential to improve the quality and cost-effectiveness of care, as demonstrated by the Federal Employees Health Benefits Program (FEHBP) and Medicare Part D. 3. Consumer-driven health plans are viable alternatives to traditional plans, and consumers should have the option of choosing such plans. 4. Proper risk adjustment mechanisms can prevent adverse selection. 5. Migrating toward value-based payment systems will result in greater quality of care at lower costs, in part by incentivizing the health care industry to make great strides in offering integrated care, innovative treatments, and personalized medicine. ABOUT THE AUTHOR Kevin D. Dayaratna, Ph.D.Senior Statistician and Research Programmer Center for Data Analysis Over the course of the past several decades, federal and state lawmakers have proposed a variety of initiatives to reform America’s health care system and reduce...
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...Assignment 2 Financing and Restructuring Health Care Dr. David Tataw HSA 500 Health Services Organization January 28, 2012 Abstract: This paper analyses the Financing and Structuring Health Care by analyzing four important notions. Firstly it Identifies and describe the three main types of health insurances in the U.S. Secondly it explains the three methods for categorizing health insurance in the U.S. This is followed by a synthesis of the pros and cons of managed health care for the health care provider, insurer, and patient. Finally the papers describe the impact of managed care on both the Medicare and Medicaid programs. Identify and describe the three main types of health insurances in the U.S. Rodts (2010) talks about the new Healthcare system in US and the challenges it brings for healthcare providers but there is always challenge when one has to select the certain type of health cover for himself. It is therefore important to understand main types of health insurance in the US. While Hall (2010) outlined the three different types of reinsurances brought about by the health reform, Health Insurance Info (2010) notes that are a number of different types of health insurance coverage designed to meet the needs and budget of a variety of individuals. In essence, health insurance is a risk management tool that ensures you and your family has access to the healthcare you need, when you need it without causing a tremendous financial burden. The cost of health insurance...
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...Decision-Making Case Study The looming changes in health care are a frequent topic in many meetings with health care providers. Budget cuts are not just a speculation but are a reality. Decision-making to provide quality patient care with less money is a challenge at best. The Informed Decisions Toolbox can assist administrators and managers with evidence-based decisions that will allow patients to receive the quality care they deserve while reducing expenses. The Informed Decisions Toolbox The Informed Decisions Toolbox (IDT) is the result of a research study to aid managers with making evidence-based decisions that improve organizational performance. The IDT has an approach of six steps to decision-making (Rundell, et al, 2007): (1) framing the management question, (2) finding sources of information, (3) assessing the accuracy of the information, (4) assessing the applicability of the information, (5) assessing the actionability of the evidence, and (6) determining if the information is adequate (p. 325). As a facilitator for the use of evidence-based research in decision-making, the IDT assists decision-makers with estimating how operational and strategic decisions will have an effect on the organization. Evidence-based decision-making is not new to the health care industry. Clinicians have incorporated evidence-based research for years when making patient treatment determination. The use of evidence-based research for decision-making in other realms of healthcare...
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...Pearson BTEC Level 4/5HNC/D Diploma Health and Social Care Unit 9: Empowering Users of Health and Social Care Services https://www.netessays.net/viewpaper/130575.html http://hndassignments.co.uk/courses/unit-9-empowering-users-health-social-care/ Student name Assessor name Fidelia Chukwuenweniwe Date issued Submission date Re-assessment date 17/02/2016 Task 1 and Task 2 Thursday 14th April 2016 Task 3 and Task 4 Thursday 28th April 2016 Assignment title Empowering Users of Health and Social Care Services Learning Outcome Learning Outcome Assessment Criteria In this assessment you will have the opportunity to present evidence that shows you are able to: Task no. LO1 Understand how the design and review of services promotes and maximises the rights of users of health and social care services 1.1 Explain how the current legislation and sector skills standards influence organisational policies and practices for promoting and maximizing the rights of users of health and social care services 1 1.2 Analyse factors that may affect the achievement of promoting and maximising the rights of users of health and social care services 1 1.3 Analyse how communication between care workers and individuals contribute to promoting and maximizing the rights of users of health and social care services 1 LO2 Understand how to promote the participation and independence of users of health and social care services 2.1 Explain factors that may contribute...
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...characteristics of those dying in the United States, to determine life expectancy, and to compare mortality trends with other countries.” ("Mortality data," 2013). Furthermore, Fleming notes three different kinds of rates, which are crude rates, specific rates and adjusted rates (2008). Based on the statistics from table 6.7 (Fleming, Pg. 141, 2008), the managed care organization BGE has a higher mortality rate (290 per 100,000) when compared to the managed care BGW (160 per 100,000) by 130 cases. To calculate which MCO has the higher morality rate (Age-specific mortality data, table 6.7), we first have to compare the results from the following equation: a) For BGW: (968,800/280,000,000) x 100,000 = 346 per 100,000. b) For BGE: (956,200/280,000,000) x 100,000 = 341.5 per 100,000. After comparing the results we can see that BGW (346 cases) has a higher mortality rate when compared to BGE (341.5 cases). To calculate the age-gender adjusted mortality rates for the managed care organizations BGW and BGE both have to be analyzed independently and the results will ten be compared. a) For BGW: (1,019,150/280,000,000) x 100,000 = 364 cases per 100,000. b) For BGE:...
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...hospital’s operation and sees to it that it remains profitable. This case analysis was conducted to: evaluate the physician’s performance in order to know whoever deserve to be granted an “admitting privileges”; to check which insurance have better coverage when it comes to payment of charges; and to determine what are the factors that affects the hospital’s revenue in order so make predictions if ever the Board keep the hospital operational what will the expected the profit and find ways on how to increase it. In the evaluating the physician’s performances we were able make an assumption that as the number of admission increases the total charges made also increases. Through comparison we found out that among the nine physicians Physician #10 delivered the most number of admissions and made the highest amount of total charges. Also, by further analysis we have strong evidence that out of the nine physicians, Physician #2 charges the most amount per patient which also contributed an increase in the hospital’s total collection. With these findings, we made a recommendation to the hospital’s Board that Physician #10 and #2 deserved to be awarded “admitting privileges”. It is said that the hospital’s revenue depend mostly to the amount that the patient’s insurance is willing to pay. As we analyzed the given data we derived with a conclusion that most of the patients that were admitted in the hospital have Managed Care Insurance. Consequently this finding tells us that the large amount...
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...Critically discuss: a) Why Cambridge Hospital Community Health Network embarked on the ABC study? There are two main reasons why the Cambridge Hospital Community Health Network (the Network) embarked on the Activity Based Costing (ABC) study. Firstly, the Network needed to gain a better understanding of its unit-of-service costs, which had been rising at a rate of 10% per year. In fact it had recently been rated the third-highest cost hospital in the state of Massachusetts. Being a high cost provider could make the Network uncompetitive for Medicaid and other public contracts. Secondly, the Network’s new operating budget required a $14 million reduction, which represented 15% of the total hospital network’s operating budget, in expenditures during the next two fiscal years. This was largely due to the downward pressure on hospital revenues by the government reform and managed care forced providers to cope with conditions that were constantly changing, while continuing to provide quality health care services in a time of intense competition. The Network's traditional method of analysing costs is the Medicare step-down costing system. It gave little information about the cost at the unit of service level. It gave only aggregate costing information (i.e. information about the departmental or global costs) but it does not provide the costs at the patient or procedure level that is needed in order to push cost reduction and also price their services competitively...
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...The Role of Technology in Rising Health Care Costs. What should or shouldn’t be done. Neha Para, MPH Student 5453-001 US Health Care System University of Oklahoma Health Sciences Center December 8, 2010 Abstract Health care costs are a longstanding concern to policymakers. For years, health care spending has been rising faster than the rate of economic growth, raising the question of what factors are responsible for rising health care costs. This paper explores published articles that report results from research conducted on technological innovations in health care and its relation to rising health care costs. The cost increases have a significant effect on households, businesses, and government programs. Health care experts indicates the development and diffusion of medical technology as primary factors in explaining the persistent difference between health spending and overall economic growth, with some arguing that new medical technology may account for about one-half or more of real long-term spending growth. Rising health care expenditures lead to the question of whether we are getting value for the money we spend. On an average, increases in medical spending as a result of advances in medical care have provided reasonable value. An alternative viewpoint holds that although new technologies represent medical advances, they are prone to overuse and thereby excess cost. Most of the suggestions to slow the growth in new medical technology in the U.S. focus on...
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...One provision of the Affordable Care Act that I am particularly in favor of, is the coverage of preventative care without being charged a copay or coinsurance (Fox & Shaw, 2014). These include specific serves for adults, children, and pregnant women. I have talked many times about the importance of preventative care. Not only is preventative care beneficial to the patient, but it can also help combat the soaring cost associated with healthcare. Having insurance coverage has always had an effect on the use of preventative services (Siu, Bibbins-Domingo, Grossman, 2015). There are now 63 preventive services covered under the ACA (Preventive Services, 2014). Studies have shown that 100,000 lives could be saved annually if people would utilize these preventative care services (Fox & Shaw, 2014). And even more impressive 9 out of 10 deaths could have...
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...|The Case For Single Payer, Universal Health Care For The United States | | | | | | | | | |Nicole Jones | |April 2011 | |HS 544 Health Policy and Economics | |Fowler | | | Table Of Contents Page Section 1: Executive Summary …………………………………………….. 3 Section 2: Introduction …………………………………………….. 4 Section 3: Literature Review ……………………………………………… 5 Section 4: Problem Analysis ……………………………………………… 10 Section 5: Solutions and Implementations ………………………………………… 17 Section 6: Justification ……………………………………………… 18 Section 7: References ……………………………………………… 20 Executive Summary Almost four decades ago, Canada and the United States had very similar health care systems. Today, they are very different. The...
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