Solved: Assignment 3: The Implications of Managed Care on the U.S. Healthcare System

Assignment 3: The Implications of Managed Care on the U.S. Healthcare System

Managed health care emerged in the early 19th century in response to the growing cost of medical services in the United States. It is an ever-evolving approach to combining the financing and delivery of health care that seeks to manage costs, increase access, and ensure or improve quality of care through a variety of methods, including provider network management, utilization management, and quality assurance.

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Solved: Assignment 3: The Implications of Managed Care on the U.S. Healthcare System
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Write a three to four (3-4) page paper in which you:

Describe the evolution of managed care and the forces that have driven its evolution.

Explain how managed care influences access to and utilization of healthcare services within the current healthcare system.

Evaluate the efficacy of managed care plans in containing healthcare costs.

Differentiate and compare at least three (3) models of managed care organizations.

Summarize at least one (1) managed care trend (i.e., evolving mixed models, managed Medicaid, managed Medicare) and appraise how this trend will affect managed care’s overall goal of managing costs, increasing access, and ensuring quality in the delivery of healthcare.

Use at least three (3) recent (i.e., last five [5] years), quality academic resources in this assignment. Note: Wikipedia and other Websites do not qualify as academic resources.

Use at least three (3) recent (i.e., last five [5] years), quality academic resources in this assignment. Note: Wikipedia and other Websites do not qualify as academic resources.

Your assignment must follow these formatting requirements:

Be typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides; citations and references must follow APA or school-specific format. Check with your professor for any additional instructions.

Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page and the reference page are not included in the required assignment page length.

The specific course learning outcomes associated with this assignment are:

Evaluate the shifts in multi-provider healthcare systems and its impact on market segments.

Assess how changes in the economic and commercial environments have affected the health sector.

Use technology and information resources to research issues in Health Care Operations Management.

Write clearly and concisely about Health Care Operations Management using proper writing mechanics.

Expert Answer

1) Shifts in the multi-provider healthcare systems and its impact on market segments:

Multi provider healthcare systems are becomingly very common these days. This has led to consolidation of smaller markets, and such consolidation has ever been increasing and impacting different market segments, and it is now quite extensive in many markets. Some of this comes from mergers and acquisitions, but an important part also comes from larger organizations gaining market share from smaller competitors. The degree of consolidation varies from market to market.

The trend in multi-provider healthcare systems is accelerating for many apparent reasons. For healthcare providers, it is becoming an increasingly challenging environment to be a small hospital or medical practice. There is more pressure on payment rates. New contracting models, such as Accountable Care Organizations (ACOs), tend to require more scale. The system is going through a challenging transition to electronic medical records, which is expensive and requires specialized expertise to avoid pitfalls. Lifestyle choices by younger physicians lead them to pursue employment in large organizations rather than solo ownerships or partnerships in small practices.

Earlier with the Conventional insurance, which is also called as indemnity or fee-for-service insurance, there were few restrictions on the choice of practitioners whose services are covered. Practitioners are reimbursed on the basis of the numbers and types of services they provide, which produces unintended consequences: an incentive for practitioners to provide more services and an incentive for patients to seek more services because they are paid for by a third party. Costs under indemnity coverage are typically controlled by higher copayments, strict limits on services, and lifetime limits on aggregate coverage.

Managed care imposes limitations on utilization by specifying which practitioners and which services are to be covered, and often checks the number of allowable visits. Managed care comes in many forms and new policies and structures continue to develop. Managed care plans have the following characteristics :

  • They make arrangements with selected practitioners to furnish a specific set of health care services to enrollees;
  • they have explicit criteria and standards for the selection of practitioners;
  • they have formal programs for ongoing quality assurance, quality improvement, and utilization review;
  • they have financial incentives for members to use the practitioners and procedures that are covered by the plan.

Currently, the feature that is most associated with managed care is cost containment. Compared with indemnity plans, managed care plans have significantly lower rates of utilization of inpatient hospitalization, lower rates of utilization of more expensive and discretionary tests, and increased utilization of preventive services.

Conclusion: Multi-provider Health care markets are becoming more consolidated, causing price increases for purchasers of health services, and this trend will continue for the foreseeable future despite anti-trust enforcement. Government can still play an effective role in addressing higher prices that come from consolidation by pursuing policies that foster increased competition in multi-provider health care markets.

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