...An Analysis of Managed Care Name: Institution: Medical costs progressively consume a large part of the Gross Domestic Product of the United States. Various sectors that seek health services including the government are increasingly turning to a regulated form of financing and delivery of health services termed as managed care. All citizen in the United States is eligible for this form of care whose purpose is to make medical care accessible for all. This paper seeks to provide a thorough analysis of managed care detailing its role in the transformation of health services, its impact on various heath aspects including access, delivery of care and financing as well as the role of managed care in promoting costs. Exploration of Managed Care Managed Care involves a system of medical provision in which patients choose preferred doctors and hospitals to visit when in need of health services and the cost of treatment is monitored by a managing company. Managed care is key to the control of health care costs that focuses on preventive care to lower cost associated with curative care. Manage Care has three forms. They are Health Maintenance Organizations (HMO), Point of Service (POS), and Preferred Provider Organizations (PPO). Managed care strategies offer financial incentives to members who control their own health care expenses for instance through the lowering the prices of prescribed drugs (Shortell, Gillies, and Anderson, 1994). Health Maintenance...
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...Achieving and Maintaining Accreditation in Managed Care Name: Institution: Devry Table of Contents Introduction………………………………………………………………………………………3 Background……………………………………………………………………………………….3 Importance of accreditation…….………………………...………………………………………3 Accreditation Bodies……………………………………………………………………………...4 Literature review………………….…………………………………………………………….....4 Challenges that are experienced in achieving and maintaining accreditation…………………..…5 The role of the URAC as an Accreditation Body………………………………………………....5 How the URAC accredits healthcare institutions….........................................................................6 Quality assessment and control solutions in accreditation ……………………………………......8 Implementation of quality improvement and accreditation solutions…………………………......9 Justification…………………………………….…………………………………………………10 Summary and conclusion……………………….…...……………………………………………10 References ………………………………………………………………………………………..11 Achieving and Maintaining Accreditation in Managed Care Managed healthcare organizations and professionals encounter numerous challenges on a yearly basis in the course of offering services, whereas the state, stakeholders, and clients (patients) expect to be reassured that bodies that render managed healthcare services are well equipped to meet their demands. Accreditation is, therefore, a detailed evaluation process through which an independent professional...
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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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...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....
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...Information Systems GPA: 3.85/4.0 Manipal University, India, B.E. in Electrical and Electronics Engineering GPA: 7.02/10.0 PROFESSIONAL SUMMARY ▪ Certified in Healthcare Management by the School of Management Science and Systems at the University at Buffalo. ▪ Thorough understanding of HIPAA and HITECH Act for health information privacy and security ▪ Six Sigma Green Belt certified PROJECTS - MS Management Information Systems Effectiveness of Nurse Communication, Spring 2012 ▪ Assessing the risks for business continuity and patient safety ▪ Study of the culture, processes, and models of communication used in hospitals Methodologies Used: Delphi, Focus Group interviews for Needs Analysis and Requirement Gathering Factors Affecting Employees’ Compliance to IT Security Policies, Fall 2011 ▪ Reviewed the various threats to information systems in an organization and the theoretical models explaining the factors that influence an employee’s adherence to IT policies. ▪ Completed a literature review of factors that affect employees’ compliance to security policies in IT industries and the measures to be taken by the senior management to improve compliance. Quality Assurance in Managed Care Organizations, Fall 2011 As a part of my course in Medical and Health Informatics, I evaluated all the features of a managed care and accountable care organization. Issues and challenges involved in assuring quality in Managed Care Organizations ...
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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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...Determine a key difference between a fee-for-service plan and a managed plan, and indicate the plan that you believe to be most advantageous for the majority of patients. Provide support for your rationale. Modern managed health care grew out of a desire to reform the traditional health care system, or the fee-for-service method of charging for health care. Under the fee-for-service method, doctors and hospitals got paid for each service they performed. There were no limits on their treatment decisions; doctors or hospitals could order as many tests as they felt necessary, for example. Doctors and hospitals made a lot of money under this system because they decided the prices charged for every visit. However, patients did not always benefit because their insurance companies would often only pay a percentage of the fees being charged.The different types of fee-for-service include indemnity plans and reimbursement plans. In an indemnity plan, the insurer sets an amount that it will pay for a specific medical service. In a reimbursement plan, the patient must pay all fees up front and then file claims to be reimbursed by the insurer. Fee-for-service health care is no longer widely in use. Most people today have some kind of menaged care insurance. There are many kinds of managed care organizations, but there are some common characteristics among them. All managed care organizations supervise the financing of medical care delivered to members. They all are concerned with cost-effectiveness...
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...mail-order medicines in the United States. This merger reflected fundamental changes taking place in the pharmaceutical industry. GROWTH IN MANAGED CARE Managed care plans typically provide members with medical insurance and basic health care services, using volume and long-term contracts to negotiate discounts from health care providers. In addition, managed care programs provide full coverage for prescription drugs more frequently than do traditional medical insurance plans. Industry experts estimate that by the turn of the century, 90% of Americans will have drug costs included in some kind of managed health care plan, and 60% of all outpatient pharmaceuticals will be purchased by managed care programs. The responsibility for managing the provision of prescription drugs is often contracted out by the managed care organizations to PBMs. The activities of PBMs typically include managing insurance claims, negotiating volume discounts with drug manufacturers, and encouraging the use of less expensive generic substitutes. The management of prescription benefits is enhanced through the use of formularies and drug utilization reviews. Formularies are lists of drugs compiled by committees of pharmacists and physicians on behalf of a managed care organization. Member physicians of the managed care organization are then strongly encouraged to prescribe from this list whenever possible. Drug utilization reviews consist of analyzing physician prescribing patterns...
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...A Marketing Plan for an Imaginary Managed Care Organization Executive Summary and Situation Analysis Working for the Managed Care Organization of America, the ultimate goal would be to ensure cooperation in the understanding, agreement, and commitment between all divisions and units. One of the problems at the Managed Care Organization of America is that the healthcare professionals are put in a position where they are inhibited in their involvement over the communication and networking systems between the Nursing Administration, the head of each nursing unit or the RN or LVN in charge, and the certified nursing aids. This executive summary takes a brief look at designing and developing a contract process program that integrates cooperation and communication systems between the Nursing Administration, the head of each nursing unit or the RN or LVN in charge, and the certified nursing aids. Another challenge for the Managed Care Organization of America is the unclear policies in the Hospital Equipment Management Program. This executive summary offers a proposal whereby the healthcare professionals would develop and monitor a two-way communication channel and incorporate it into the Hospital Equipment Management Program, hold related workshops that can be attended by the Director of Hospital Operations and the division managers, build a cooperation team that unites operational goals and develop systems that evaluate whether these operational goals are being met and implemented...
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...society today is health care reform and government plays a large role in regulating managed health care systems. A vast difference between movement along and shift in the demand curve for the different health care systems. For instance, the government funds Medicaid and Medicare to provide services to the indigent and disabled population. However, many factors exist that influence the control of health care spending from an economic standpoint. The objective of this paper is to discuss the role of government and the supply and demand curves concept to show the difference between movement along and shift of the curves in the managed care system. The concept of medical price elasticity to evaluate the manage health care industry is also discussed. Resource Allocation Law makers presented several proposals for health care reform and the final bill passed with the intention of providing health care to all Americans. One important issue concerning many consumers about health care reform is the selection of an appropriate managed health care program because one must choose a managed care provider by December 31, 2010. The application of principles to understand the health care systems is challenging because of the complexity of health care as a product or service; however, the fundamental problem addressed by economics is allocation of limited resources among unlimited demand (Scott, Solomon, & McGowan, 2001). Such is the case in the health care industry. According...
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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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...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 Canadian system is predominantly...
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...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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...Managed Care Staci Berry MHA614 Policy Formation & Leadership In Health Organizations Instructor: Judy Roberts April 2, 2013 Managed Care In this paper we will discuss managed care. We will find and discuss the definition of managed care. This paper will also explain the different types of managed care plans that are available to Americans. This paper will provide examples of the different types of managed care plans available. It will also explain how each plan works. We will also talk about why rising exposure to health care costs are threatening the well-being of American families. According to Harrington and Estes, managed care is a term that has been overused and really does not have a specific meaning. “Originally, it referred to health care delivered with a capitated financing mechanism. Then it included health care delivered through contracting networks. Currently it refers to most any health are delivery that is different from fee-for-service health care delivery” (Harrington & Estes, 2008 pg.42). When dealing with managed care usually there is a panel of providers that the individual can use. If they go outside of this panel they will be more likely to have to pay a higher copayment or deductible. Some characteristics of a managed care health plan delivery system include: “explicit standards for the selected health car providers, it also puts emphasis on preventive care, as well as provides financial incentives to ensure the use of the...
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...Managed Care Describe the beginning of ACO In 2011, the US Department of Health and Human Resources has proposed the guidelines for Accountable Care Organisation (ACO) under the Medicare shared saving Program. The Patient Protection and Affordable Act authorises CMS to create the MSSP that help doctors, hospitals and other health care provider in coordinating care for Medicare patients through ACO. An ACO is a network of group of provider and suppliers who work together to provide high quality care for the Medicare Fee-for service patients they serve. The ACO model was developed by Fisher, that private hospitals and organisation can be grouped into virtual organisation that is accountable for cost and quality of the range of care services delivered to Medicare patients. ACO work to provide high quality care to Medicare enrolees while simultaneously reducing health care costs. ACO is accountable to beneficiaries of Medicare for cost, quality and care. Till now eight private health insurance plans have entre with provider into ACO agreements that shares a payment risk model. Keeping the cost below a benchmark will make providers eligible for bonuses and incentives (Berenson & Burton, 2012). Objectives of ACO The main goal of ACO is to provide effective, accessible and coordinated care to patients it serves. ACO assures that care is delivers in a cultural component manner. The organisation aims to deliver seamless supreme quality care to beneficiaries of Medicare...
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