Preview

Managed Care Research Paper

Better Essays
Open Document
Open Document
1001 Words
Grammar
Grammar
Plagiarism
Plagiarism
Writing
Writing
Score
Score
Managed Care Research Paper
Managed Care

MHA 614 Policy Formation & Leadership in Health Organizations
Instructor: Alisa Wagner
June 29, 2015

Managed Care Signed by President Barrack Obama in March of 2010, the Affordable Care Act (ACA) placed an emphasis on the expansion of health insurance coverage. Eligibility will be expanded to people with incomes up to 133 % of the FPL, including the nondisabled, nonelderly adults without dependent children (Boemer, 2015, P. 58-60). It has guaranteed access to health care for every American. Managed care has not been holding up to its promise. According to our textbook, “the optimistic claim that managed care would bring improved clinical practices, higher quality of care, and maintain the public’s health,
…show more content…
15-29). As the Medicaid program continues to grow, managed care has become Medicaid’s dominant delivery system. Managed care has become increasingly important to state Medicaid agencies. Many states are partnering with Medicaid Focused Health Plans (MFHPs) that can supply cost-effective care and help states meet quality improvement goals. According to Smith, Arose, & Coustasse (2014), since 1999, enrolment growth for MFHPs have averaged 14.5 % per year. Medicaid manage care has grown to serve 39 million beneficiaries, or 71.4 % of all Medicaid enrolees (p. 15-29). Each state is custom tailored to meet the special needs of the beneficiaries, providing financial, operational, and leadership …show more content…
Controlling costs involves identifying and supporting the care of patients suffering from chronic disease. To accomplish this leadership needs to enact strategies to shift how care is delivered. One can start by identifying high risk patients early on and implementing proactive disease and case management programs. While varying from one company to another, managed care has not limited access to hospital admission or to general medical care. According to recent studies, “managed care is the rubric applied to a range of organizational forms that emerged in the last couple of decades in which a variety of structures, mechanisms, and utilization strategies are used to allocate care so as to reduce unneeded services and constrain cost” (Fera,

You May Also Find These Documents Helpful

  • Best Essays

    A few years ago, some opined that managed care was either dead or nearly dead. Years later, managed care seems stronger than ever, or is it? After reading the background information, conduct additional research and respond to the below questions.…

    • 1477 Words
    • 5 Pages
    Best Essays
  • Satisfactory Essays

    Managed Care Case Study

    • 167 Words
    • 1 Page

    Managed care contributes a vast amount to the healthcare system. Without managed care systems I don’t think health facility, insurances agencies and companies would manage. Agree, professionals are to adapt and accommodate changes based on contracts between managed care systems and other agencies. In my opinion, the technology advancement within the health care system has improved tremendously in a positive way. For example; when I switched my daughter primary doctor around shot time, me being old fashion handed her the paper shot record. She replied “ma’am it already imported into the system; we don’t use the paper anymore.” This is totally a successful and less stressful outcome on a person if it was to get lost or misplaced. These…

    • 167 Words
    • 1 Page
    Satisfactory Essays
  • Powerful Essays

    The cost of health care in the United States remains an important concern for American consumers. The challenges for controlling costs and providing a better health care system are various and complex. These challenges, in many cases, are in the realm of the Department of Health and Human Services (HHS) or other federal or state agencies (Department of Justice, 2012). Hospitals continue to team up with other facilities, insurers and for-profit companies, although the cause of the bump in M&A activity varies. While some hospitals cite financial problems, others join forces because of collaboration mandated under the Affordable Care Act and changing reimbursement models, according to Minnesota Public Radio (Caramenico, 2012).…

    • 1722 Words
    • 7 Pages
    Powerful Essays
  • Good Essays

    Managed Care Case Study

    • 792 Words
    • 4 Pages

    For the past several years, the health care and insurance industries in America have been undergoing significant reform in order to rein in the high cost of delivering health care services. Managed care has become a cornerstone of this process (Strickland, 1995). The case management industry (with its focus on cost containment, managed competition, and quality care) is playing an increasingly important role in the managed care environment (Owens, 1996). According to Mullahy (1995a), the number of case managers has risen astronomically in recent years. These individuals come from diverse professional backgrounds and practice settings that include nursing, rehabilitation counseling, and social work.…

    • 792 Words
    • 4 Pages
    Good Essays
  • Better Essays

    Porter-O 'Grady, T., & Malloch, K. (2007). Managing for success in health care . St. Louis, MO: Mosby.…

    • 1182 Words
    • 3 Pages
    Better Essays
  • Satisfactory Essays

    The Affordable Care Act is the greatest overhaul of the US health-care system. One of its key reforms includes health coverage for adults with pre-existing conditions, which generally hadn’t been available until now. The Affordable Care Act was signed into law by President Obama in March 2010. The act will extend insurance to more than 30 million uninsured people.…

    • 91 Words
    • 1 Page
    Satisfactory Essays
  • Better Essays

    health care system is dysfunctional and can no longer continue as it currently operates. With or without Affordable Care Act (ACA), there is a need for a deep change. The United States spends more money on health care because a nation is less healthy on the average than the rest of the developed world. The system is dysfunctional and ACA is fast-tracking the process of changes that will be faced by the economic and business challenges by health care organizations. The required adjustments to healthcare organizations operating budgets and methodologies for delivering medicine may become a big issue. Health care organizations will have to go from volume-based reimbursement in medicine based on the number of procedures done or patients seen to a value-based system that will give the same money for every patient regardless of the procedure performed. Health care organizations may have lower income since they will treat more patients. They may face cost-pressure factors such as the overall cost of medical care and the increased incidence of chronic disease, cost transparency and reference pricing, increased government role in paying for care, increased coverage and limited highly skilled medical workforce There is a prediction that forty million more people will be covered nationally, at reimbursement rates below the cost of providing that care (Adams et al.,…

    • 1835 Words
    • 8 Pages
    Better Essays
  • Powerful Essays

    Mainly, as a result of managed care in the 1990's, the healthcare system is perceived to be on the decline, i.e. increased cost, poor quality care, increased number of uninsured, mistrust of the providers and insurers, unethical behavior by both insurers and providers, etc (Fottler & Malvey, 2004). On the macro level, insurers shaped these perceptions by high insurance premiums and those that are out of reach for many Americans (who remain uninsured). Unethical behavior by insurers hasn't helped the matter either. Healthcare executives should develop better leadership and public relations savvy. Many institutions have incurred a world of trouble when they were perceived as violating fundamental values. The introduction of managed care resulted in the eroding of public trust and perceptions of a steady decline (due to medical errors, increased workload, eroding physician-patient relationship, less people insured, etc.) in the healthcare system (Teixeira, 2005). Low levels of trust amongst providers and insurers also lead to mistrust, low level care, etc. The level of trust in the industry has dipped to a critical level. Nurses distrust doctors. Doctors hate insurers andmanaged…

    • 1492 Words
    • 6 Pages
    Powerful Essays
  • Satisfactory Essays

    Managed care is any arrangement in health care in which an organization like HMO or…

    • 476 Words
    • 2 Pages
    Satisfactory Essays
  • Good Essays

    Miller, R.H. (2015). Does managed care lead to better or worse quality of care? Retrieved from http://content.healthaffairs.org/content/16/5/7.short…

    • 727 Words
    • 2 Pages
    Good Essays
  • Better Essays

    Evolution of Managed Care

    • 1519 Words
    • 7 Pages

    References: Davis, K., Collins, K., & Morris, C. (2006). Managed Care: Promise and Concerns. Retrieved on August 25, 2010, from http://content.healthaffairs.org/cgi/reprint/13/4/178.pdf…

    • 1519 Words
    • 7 Pages
    Better Essays
  • Good Essays

    Introduction: According to Terence Shea in an article published by HR Magazine (2005), in the last fifty years, employers' health cost have soared as coverage has expanded and medical care has been revolutionized. Since the early 1980s, there have been a number of governmental and corporate attempts to slow this dramatic rise in health care expenditures. Most health plans in the U.S. today involve some form of managed care. Nearly 90 percent of Americans with health insurance are covered by HMOs and other managed-care plans. The reason for the shift from the traditional to managed care plans was to hold down healthcare costs. As HMOs grew physicians in private or small group practices have become…

    • 821 Words
    • 4 Pages
    Good Essays
  • Best Essays

    Managed Care History

    • 4302 Words
    • 18 Pages

    Managed care plans and other insurers: By better understanding the past and present of managed care plans and other insurers in the USA, we can make well-grounded statements about its challenges and proper ways of answering them; furthermore, having a health care plan can help to help improve your chances of getting medical treatment to control and reduce the risk of sickness and disease.…

    • 4302 Words
    • 18 Pages
    Best Essays
  • Best Essays

    Medicare and Medicaid

    • 3491 Words
    • 14 Pages

    There is no doubt that the health insurance landscape of today’s society is drastically different than what our grandparents experienced decades ago. With health insurance reforms and the growth of a health insurance marketplace, the government hopes to ensure health coverage for more Americans than ever before. The health insurance paradigm has shifted from a privilege to a basic right, but it has not come without immense debate, discussions over the quality of care and its rising costs. The new reform proposed by the Obama administration to insure every American has sparked…

    • 3491 Words
    • 14 Pages
    Best Essays
  • Powerful Essays

    Accreditation Audit Task 1

    • 1716 Words
    • 6 Pages

    Shortell, Stephen M., and Arnold D. Kaluzny. Health care management: organization, design, and behavior. 5th ed. Clifton Park, NY: Thomson Delmar Learning, 2006. Print.…

    • 1716 Words
    • 6 Pages
    Powerful Essays