The Evolving Role of Managed Care

The United States spends a larger percentage of GDP on healthcare than any other developed nation, but scores on the lower end of all quality and effectiveness indicators. This leads to a national dialogue on how to promote and innovate healthcare while doing it in a most efficient manner, both resource and financial distribution, possible. Managed care are health insurance and financing plans which attempt to lower health care costs through a wide variety of mechanisms such as reducing unnecessary testing, beneficiary cost sharing, service optimization, selective contracting of providers, and improving patient admissions and lengths of stay. Medicaid has numerous long-term managed care plans.

The role of managed care is beginning to expand in scope. While traditional plans include a fee-per-service model, emphasizing billing based on disease and rarely covering serious illnesses, managed care focuses on a wellness perspective. Managed care directs resources to disease prevention through wide coverage of regular checkups and treating illnesses at early stages. Numerous managed care organizations have emerged, with specialists and facilities offering such services at minimum monthly fees (Shrank, Keyser, & Lovelace, 2018).

The primary method of cutting costs through managed care is the reallocation of resources from medical to social services. Managed care has a more engaged delivery system along with the better trust of the population. Such providers have the incentive and unique position to offer and measure the effect of a blend for medical and social services with the hopes of achieving positive outcomes. This redistribution of resources remains uncertain, but a likely partnership between managed care organizations and the government at all levels will have an impact on improving the health of populations and offsetting long-term treatment costs. In turn, these resources can be redirected to providing health services to groups not covered by managed care plans (Shrank et al., 2018).

One of the leading arguments against managed care is that without financial incentive and market competition, the socially-based system will decline in quality. However, there is still competition in terms of network composition (participating physicians, specialists, and facilities), quality of care, and some government financing. In addition, the engagement and passion of these organizations are often beneficial in increasing quality, despite sometimes lacking the resources or trained staff to fulfill objectives.

For example, the state of California has one of the largest managed care programs under Medicaid. Based on the Healthcare Effectiveness Data, managed care beneficiaries score consistently higher rather than private plans. However, there is an issue of limited access to care as small networks are currently unable to cope with patient loads and needs that are enrolled in the state Medicaid program (Bindman, 2018).

Managed care is becoming more complex as it expands, focusing on specific populations and components of care. Under the Affordable Care Act, new provisions were added to Medicaid and other federal regulations to assess, develop, and maintain a level of quality to managed care services offered as well as offering quality strategies (Shrank et al., 2018). A regulatory backlash beginning with the early 2000s led to significant increases in managed care quality. This particularly due to policymakers utilizing reimbursement systems for medical organizations and personnel to meet specific criteria regarding cost, quality, and patient satisfaction benchmarks. Regulations serve as the primary mechanism of controlling the quality of managed care with improvements in both access and patient outcomes over the long-term (Highfill, 2017).

References

Bindman, A. (2018). Redesigning Medicaid managed care. JAMA 319(15), 1537-1538. Web.

Highfill, T. C. (2017). Patient outcomes and managed care: What was the impact of the state regulatory backlash? Web.

Shrank, W. H., Keyser, D. J., & Lovelace, J. G. (2018). Redistributing investment in health and social services—The evolving role of managed care. JAMA, 320(21), 2197-2198. Web.

Calculate the price
Make an order in advance and get the best price
Pages (550 words)
$0.00
*Price with a welcome 15% discount applied.
Pro tip: If you want to save more money and pay the lowest price, you need to set a more extended deadline.
We know how difficult it is to be a student these days. That's why our prices are one of the most affordable on the market, and there are no hidden fees.

Instead, we offer bonuses, discounts, and free services to make your experience outstanding.
How it works
Receive a 100% original paper that will pass Turnitin from a top essay writing service
step 1
Upload your instructions
Fill out the order form and provide paper details. You can even attach screenshots or add additional instructions later. If something is not clear or missing, the writer will contact you for clarification.
Pro service tips
How to get the most out of your experience with My Homework Geeks
One writer throughout the entire course
If you like the writer, you can hire them again. Just copy & paste their ID on the order form ("Preferred Writer's ID" field). This way, your vocabulary will be uniform, and the writer will be aware of your needs.
The same paper from different writers
You can order essay or any other work from two different writers to choose the best one or give another version to a friend. This can be done through the add-on "Same paper from another writer."
Copy of sources used by the writer
Our college essay writers work with ScienceDirect and other databases. They can send you articles or materials used in PDF or through screenshots. Just tick the "Copy of sources" field on the order form.
Testimonials
See why 20k+ students have chosen us as their sole writing assistance provider
Check out the latest reviews and opinions submitted by real customers worldwide and make an informed decision.
11,595
Customer reviews in total
96%
Current satisfaction rate
3 pages
Average paper length
37%
Customers referred by a friend
OUR GIFT TO YOU
15% OFF your first order
Use a coupon FIRST15 and enjoy expert help with any task at the most affordable price.
Claim my 15% OFF Order in Chat

escort

-
eskişehir escort

escort

-
eskişehir escort
Live ChatWhatsApp

escort

-
eskişehir escort