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Managed Healthcare Organizations

by | Mar 26

Research managed care’s inception and study some examples. Be sure to investigate the perspectives about managed care from the vantage of both healthcare providers and patients. You can use the following keywords for your research—United States managed care, historyof managed care, and managed care timeline.
Based on your research, answer the following questions in a 8- to 10-page Microsoft Word document:
• What are the positive and negative aspects of managed care? Analyze the benefits and the risks for both providers and patients, and how providers should choose among managed care contracts. Conclude with your analysis and recommendations for managed care healthplans. Your response should include answers to the following questions:
o Summarize the history of when, how, and why managed care was developed.
o Define and discuss each type of managed care organization (MCO)—health maintenance organization (HMO), preferred provider organization (PPO), and point of sale (POS).
o Explain the positive and negative aspects, respectively, of managed care organization from the provider’s point of view—a physicianand a healthcare facility—and from a patient’s point of view.
o Explain the three types of incentives for providers for efficiency in the delivery of healthcare services. Explain whobears the financial risk—the provider, the patient, or the managed care organization.
o Offer your recommendations, to accept or decline, for patients considering managed care health plans, with your rationale for each.
References:
Claxton, G., Rae, M., Panchal, N., Damico, A., & Lundy, J. (2012). Employer Health
Benefits Annual 2012 Survey. Retrieved from http://ehbs.kff.org/pdf/2012/
8345.pdf
Sekhri, N. K. (2000). Managed care: The US experience. Retrieved from http://www.
who.int/bulletin/archives/78%286%29830.pdf
Scutchfield F. D., Lee, J., & Patton, D. (1997). Managed care in the United States.
Journal of Public HealthMedicine, 19(3), 251-254. Retrieved from http://
jpubhealth.oxfordjournals.org/content/19/3/251.full.pdf
Support your responses with examples.
Cite any sources in APA format.

http://www.insurance.com/health-insurance/health-insurance-basics/understanding-the-difference-between-hmo-ppo-and-pos.aspx

• What are the positive and negative aspects of managed care? Analyze the benefits and the risks for both providers and patients, and. Conclude with your analysis and recommendations for managed care health plans. Your response should include answers to the following questions:

Positive aspects associated with managed care entail the fact that these organizations are structured around a variety of incentives that can provide incentives for healthcare physicians to practice of cost-effective medicine that theoretically should be able to allow for minimization of variation in clinical practice patterns. The objective is to minimize the resources that are used or save money while maximizing the productivity and lowering costs to the patient. The use of managed care should allow for healthcare practitioners to do more with less that can lower overhead costs for patients thus lessening costs of medicines and allowing for fewer costly diagnostic tests and treatments.

Some of the problems associated with managed care are that often the use of monetary incentives is often used to affect physician behavior. This can be efficient when the rewards are predicated upon lowering costs for patients as well as maintaining the type of service that ensures that patient’s health is the main objective but often this leads to physicians that are spending less time with patients and restricting patient’s access to tests and treatments. The common perspective is that the financial well-being of employer’s such as hospitals and clinics are placed above the needs of patients. Physicians that are deemed to have completed too many procedures are seen as cost-inefficient are penalized in the form of withholding of bonuses or portions of their income. This lessens the desire for doctors …

Different types of MHOs.

  

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