Discussion Reply- Response 1-2 paragraphs with 1-2 references

Antoinette Tuddles

Hello Everyone!

As a healthcare administrator, I would recommend the utilization of a managed care plan. These are health plans that manage care by integrating the financing and delivery of specific healthcare services, such as an HMO (Casto, 2018). My organization should adopt this plan because its goal is to control costs and provide quality and affordable healthcare (Casto, 2018).

Some of the advantages of a managed care plan are it lowers the costs of health care for those who have access, people can seek out care from within the network of providers, and physicians can treat the whole person with a Primary Care Physician (PCP), who acts as a gatekeeper (Casto, 2018). The gatekeeper’s role is to control costs. Case management coordinates patient care for the most complex and high-cost cases. Providers must undergo accreditation processes to ensure that health care is provided effectively. Also, prescription management is a cost-control measure where providers may order generic brands of drugs as opposed to their more expensive brand name counterparts (Gaille, 2017). Providers are paid via capitation and can track revenue a bit easier through this method of payment. There are also incentives provided when meeting goals of cost-efficiency.

Some of the disadvantages of the managed care plan are that networks can become very busy based on the population it serves, causing long wait times to get an appointment. This can be a dissatisfier for patients and can result in not meeting specific incentives. Various other penalties can be accessed for not meeting incentive targets. There are also other disadvantages such as the increased costs of unapproved care, which results in collection efforts that may not be met (Kimuyu, 2018).

The advantages and disadvantages of managed care plans are that it can be an effective system of health care management. However, it must be proactively managed to remain beneficial (Gaille, 2017).