responses week 10

Response 1

Managed care is a program or organizations which established in the 1980s for the cost-containment purpose. The cost-containment achieved through the reduction of unnecessary health care costs in a variety of mechanisms. There are three types of managed care plans: Health Maintenance Organizations (HMO) Point of Service (POS) plans let you choose between an HMO or a PPO each time you need care. Preferred Provider Organizations (PPO) usually pay more if you get care within the network (MedlinePlus.gov).

The mechanisms used to contain health care cost are:

· Provision of economic incentives for physicians and patients to select less costly forms of care.

· Established programs for reviewing the medical necessity of specific services.

· Increased beneficiary cost sharing.

· Controlling the inpatient admissions and lengths of stay by the primary care physicians.

· Establishing some cost-sharing incentives for outpatient surgery.

· Providing selective contracts with health care providers, and

· Evaluation of high-cost health care cases

In 2009, the Oregon Health Authority introduced a new system called Coordinated Cost Organizations (CCO) to replace the Managed Care Program. CCO model may face several implementation challenges. However, if CCO program succeeds, the results of its experiment will offer important lessons for other states (Haward et al., 2015)..

As the Affordable Care Act (ACA) of 2010 has required an expansion of Medicaid eligibility, states have continued to turn to Medicaid managed care as a strategy to contain costs and effectively meet the needs of a growing population (Smith et al., 2014). The cost of Medicaid Managed Care continues to rise which started long ago before ACA enacted. For example, between 2000 to 2007 alone the Medicaid Managed Care plan expenditures rose from $27 billion to $61 billion. Therefore, the future of Managed Care is unknown at this point because it may be losing its popularity as the cost of healthcare, in general, continue to rise. Also, it may replace by the CCO, if the Oregon Health Authority plan become successful.  

References

Howard, S. W., Bernell, S. L., Yoon, J., Luck, J., & Ranit, C. M. (2015). Point-Counterpoint. Oregon's Experiment in Health Care Delivery and Payment Reform: Coordinated Care Organizations Replacing Managed Care. Journal of Health Politics, Policy & Law, 40(1), 245-255.

MedlinePlus. U.S National Library of Medicine. Retrieved from: https://medlineplus.gov/managedcare.html

Smith, R., Arose, N., & Coustasse, A. (2014). The Impact of The Affordable Care Act In The Medicaid-Focused Managed Care Plans. Insights to A Changing World Journal, 2014(3), 15-29.

Response 2

Managed care can be defined as any medical expense plan that limits costs by modifying the behavior of participants using a comprehensive set of services. It is a method of organizing health care providers to achieve the goals of controlling health care costs and managing quality of care by providing a wide range of services for a fixed, periodic prepayment. Managed care plans have contracts with health care providers and medical facilities to provide care for members at reduced costs. These providers make up the plan's network.  Members (patients) are required to utilize the plan’s providers for all services.  Critics of the plan see this as a disadvantage because it limits what doctors they can see. 

One of the largest managed care organizations, Kaiser Permanente, was started by a surgeon running a small hospital in California to serve construction workers.  It became an HMO with its own doctors and hospital in the mid-1940s and expanded beyond California over the next 50 years.

I believe managed care will be around in another 10-20 years.  Looking at Kaiser Permanente of which I am a member, Kaiser is experimenting with ways to provide care at home or over the Internet, without the need for a physical office visit at all in an effort to reduce healthcare costs even more.  Lowering costs includes finding ways to get members to take more responsibility for their health such as losing weight or lowering blood pressure.  Kaiser has also recently adopted a plant based diet to encourage healthy eating.

The days when doctors, hospitals and other providers are paid separately for each procedure will disappear eventually and be replaced with the managed care model.   

Abelson, R. (2013, March 20). The Face of Future Health Care. Retrieved April 4, 2017, from http://www.nytimes.com/2013/03/21/business/kaiser-permanente-is-seen-as-face-of-future-health-care.html

Response 3

Managed care organization which provides managed care as medical expense plan to limit the costs by modifying the behavior of consumer. Managed care organization has following characteristics:

1: Risk sharing: the successful managed care organization the financial consequences of the medical plan decisions. They encourage cost effective care. Doctors eliminate unnecessary test and procedures.

2: Control access providers: Unrestricted access to physicians and hospitals makes it difficult to control cost. This limitation allows them to negotiate fess.

3: Comprehensive case Management: Utilization reviews at all level is an important part of successful managed care organization. Any medical plan should be review to measure its cost effectiveness and service to people.

4: High quality care: Managed care organization carefully selected their staff doctors and nurses. They must provide high quality of care to patients. Doctors and nurses are certified with standard necessary experience in their field. Special raining provided to support staff to ensure high quality of care. Labs and Nurses are licensed.

5: Preventive care: Healthier life style and preventive care maintenance are two main features of a managed care organization. These organization prevent illness, promote good health. Change unhealthy habits and cope with health problem and issues.

The future of managed care is bright.

https://academic.udayton.edu/health/02organ/manage01d.htm

response 4

Managed care organization is defined as a health care delivery system in the United States developed to manage cost, utilization, and quality of health care services. Medicaid managed care provides for the delivery of Medicaid health benefits and additional services through contracted arrangements between state Medicaid agencies and managed care organizations (MCOs) that consents to a set of payment for each member per month via capitation mode of payment for the services provided (Medicaid, n.d).

Working in hand with various types of MCOs in delivering Medicaid program health care services to their beneficiaries, the state can minimize Medicaid program costs and better manage utilization of health care services. Improvement in health care plans and discharge, health care quality and outcomes are main target of Medicaid managed care (Medicaid, n.d).

Some states are implementing a range of initiatives to coordinate and integrate care beyond traditional managed care. These initiatives are focused on improving care for populations with chronic diseases such as diabetes and hypertension whereby aligning payment incentives with performance goals and building in accountability for high-quality care (“Medicare.gov”).

References

Medicaid,( n.d). In health insurance Retrieved from https://www.medicaid.gov/federal-policy-guidance/federal-policy-guidance.html

Medicare.gov (n.d.). In prepferd provider organization(PPO). Retrieved from https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/preferred-provider-organization-plans.html