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Managed Care Literature Review

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Literature Review
Healthcare officials are trying to transition special needs children to a managed care system without threatening health outcomes and quality of care. According to Knapp, Madden, Sloyer and Shenkman, children with special needs make up “approximately 13.9%” of the United States’ children population (2011, p.1). Therefore, shifting special needs children healthcare programs from a fee-for-service model to a managed care system needs to focus primarily on three components: care coordination, the roles of pediatricians, and accessibility to specialty and primary care providers.
Coordination of care is necessary to ensure that these special needs children receive the services at a directed time, rather than during a time of emergency. …show more content…
These pediatricians become the medical home by overseeing the course of treatment for their patients. There is a belief that pediatricians should coordinate the care for their special needs patients to increase continuity and build trust with the family of these children (Kastner, 2004). This is a rational assumption because pediatricians have intimate knowledge of a patient’s history and would be able to coordinate care better. However, the roles of pediatricians are limited due to time constraints, substandard reimbursements, and lack of training (Ireys, Grason, & Guyer, 1996). Pediatricians are not given the tools to properly coordinate care, which leads to the poorer quality of care. Reimbursement for pediatricians caring for special needs children is a topic of contention because scheduled fees may hinder the quality of care received. Kastner argued that carveouts can “prevent pediatricians from being reimbursed for services” (2004, p. 1694). Under a managed care program, pediatricians are reimbursed on a set system that does not incentivize higher quality of care. Pediatricians need to actively participate in rewriting current policy to resolve these types of issues to provide the highest quality care to their patients with special …show more content…
According to Mitchell and Gaskin (2004), the largest area of concern of accessibility is the difficulty of getting an appointment to see a specialist or primary care physician. Once accessibility to services becomes problematic, then quality of care decreases eventually affecting health outcomes. Additionally, the reduced number of pediatric subspecialists is causing delays in treatments for these children (Ireys et al., 1996). A managed care system aims to address these concerns. Therefore, these issues in the current managed care system needs to be resolved quickly to decrease the chance of further degradation of these children’s

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