Discussion question

There are many kinds of managed care plans—an alphabet soup—for example, with PSOs, PPOs, and HMOs the most prominent. Managed care plans use a number of techniques. Some of them are directed at physician behavior. Others are directed at subscribers to the plan.

1. What do you believe to be the major obstacle to access in managed care? Be sure to provide support for your position.
2. Discuss some of the ethical concerns and what you would do about the ones you discussed.

REQUIREMENTS: 1 PAGE, APA FORMAT

Required Readings

Blumenthal, D., Chernof, B., Fulmer, T., Lumpkin, J., & Selberg, J. (2016). Caring for high-need, high-cost patients—an urgent priority. New England Journal of Medicine, 375(10), 909-911.

Bridger, C. M., Smith, S. E., & Saunders, S. T. (2017). Saving lives and saving money: The role of North Carolina health departments in Medicaid managed care. North Carolina Medical Journal, 78(1), 55-57.

Cleverley, W. O., & Cleverley, J. O. (2017). Essentials of health care finance. Jones & Bartlett Learning.

Hines, A. L., Raetzman, S. O., Barrett, M. L., Moy, E., & Andrews, R. M. (2017). Managed care and inpatient mortality in adults: Effect of primary payer. BMC Health Services Research, 17 doi:10.1186/s12913-017-2062-1

Keast, S. L., Skrepnek, G., & Nesser, N. (2016). State Medicaid programs bring managed care tenets to fee for service. Journal of Managed Care & Specialty Pharmacy, 22(2), 145-148.

Mahmoudi, E., Tarraf, W., Maroukis, B. L., & Levy, H. G. (2016). Does Medicare managed care reduce racial/ethnic disparities in diabetes preventive care and healthcare expenditures? The American Journal of Managed Care, 22(10), E360.

McGinnis, T., Houston, R. & Brown, D. (2013) The balancing act: Integrating Medicaid accountable care organizations into a managed care environment. Center for Health Care Strategies: Issue Brief. Retrieved from: https://www.chcs.org/media/ACO111313_Final.pdf

Richard, D. (2017). What is next for behavioral health in managed care? North Carolina Medical Journal,78(1), 30-32. doi:10.18043/ncm.78.1.30.

Schafer, J., Galante, D., & Shafrin, J. (2017). Value tools in managed care decision making: Current hurdles and future opportunities. Journal of Managed Care & Specialty Pharmacy.

Thompson, B. & Robbins, A. (n.d.) Understanding managed care. Washington State DSHS. Retrieved from: https://www.dshs.wa.gov/sites/default/files/BHSIA/dbh/Integration/Webinar%20Understanding%20Managed%20Care.pdf

Uriarte, J. (2015, August 10). 6 Dimensions of Healthcare Quality [Video file]. Retrieved from https://www.youtube.com/watch?v=QexTk38euzY

Walters, T., Parcher, B., Kravetz, A., Campbell, C., Shah, M., & Hale, T. (2016). Appraising the value of digital health technologies from the managed care perspective: Insights for evidence assessment and reimbursement in the United States. Journal of Medical Internet Research, 18(12).

Wang, Tze-Fang; Shi, Leiyu; Nie, Xiaoyu; Zhu, Jinsheng. (2013). Race/ethnicity, insurance, income and access to care: The influence of health status. International Journal for Equity in Health, 12(1), p.29