Description Of A Managed Care Essay

Description Of A Managed Care Essay

Length: 952 words (2.7 double-spaced pages)

Rating: Better Essays

Open Document

Essay Preview

Defining Managed Care

Managed care is a system put in place to control the cost of health care. Managed care growth began in the 1990’s and prevents users of medical insurance from over using or abusing the medical systems. The mange care model is made up of different types of plans. These plans consists Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Point of Service plans (POS), and Indemnity insurance plans.

Defining Accountable Care Organizations
According to Kongstvedt (2013) an Accountable Care Organizations (ACO) is described as a type of care that is made up of a group of providers that deliver care to a specific group of beneficiaries. ACOs also take on the financial risk of the patient they are taking care of. In relation to behavior/mental health disorders ACO’s do not professional in the specialty of behavioral health.

Impacted By the Affordable Care Act

Before the establishment of the affordable care act in the in 2010, ACO did not have to include care to patients with behavioral health needs. Individuals who needed care had to use some other type’s network coverage plan in order to pay for the cost of care. The Affordable Care Act (ACA) along with the Patient Protection Act and the Mental Health Parity and Addiction Equity Act it has since been mandated that behavioral health services be covered by ACO’s. Since this the passing of this law ACO would have to change their methods on the delivery or behavioral health services. According to the writers The Role of Behavioral Health Services in Accountable Care Organizations (2015) journal article ACO’s would need to begin exploring contracts options in order to fulfill the requirement.

Instead of using third party payers and othe...

... middle of paper ...

...ied more high-risk individuals more quickly and providing them with the most effective treatments. This over time could lead to a decline in the number of people using facilities such as behavioral health lowing to the cost spent on mental health care.
The needed to be a change in how care was given. In order for the CCM to be effective more provider would be needed. Studies have shown that about 61% of all Medicare patients are eligible for the Chronic Care Program (CCM). There are indicators that primary care services would see an increase in weekly hours by about 12 hours per week. Calculations found in an editorial entitled Medicare Chronic Care Management Payments and Financial Returns to Primary Care Practices stated that the use of nonphysical staff (RN’s or LPN’s) practices. The use of these type of providers would also aid in lower the cost for treatment.

Need Writing Help?

Get feedback on grammar, clarity, concision and logic instantly.

Check your paper »

The Internal Organization Of Managed Care Organizations Essay

- As the managed care organizations continues to expand, and as the affordable care is taking root in the United States. The country in its entirety relies on managed care to assure access, manage costs and provide comprehensive services. Hence, it is imperative that the Managed care departments work in Unisom to achieve optimal health care for their customers. Therefore it is important to analyze and understand the internal organization of managed care organizations (MCOs). The internal operation of a typical managed care organization consists of the following: Marketing and sales department Enrollment and billing Claims administration Member services Finance Actuarial And underwriting...   [tags: Health care, Managed care, Health insurance]

Better Essays
1017 words (2.9 pages)

Managed Health Care Issues Essay

- When one examines managed health care and the hospitals that provide the care, a degree of variation is found in the treatment and care of their patients. This variation can be between hospitals or even between physicians within a health care network. For managed care companies the variation may be beneficial. This may provide them with opportunities to save money when it comes to paying for their policy holder’s care, however this large variation may also be detrimental to the insurance company....   [tags: Health Care, Utilization Management]

Better Essays
3218 words (9.2 pages)

Description of Ambulatory Care and Hospitalization Care Essay

- As early as the 1990’s, outpatient care only made up for 10 to 15% of a hospital’s total profits, compared to inpatient care. Since the start of the twenty-first century, this figure has increased to approximately 60%. This shift in healthcare has been occurring in different medical organizations such as university medical centers, local hospitals, for-profit chains, and not-for-profit suppliers. The increase in outpatient services compared to inpatient has been showing no indication of slowing down....   [tags: health system, outpatient care, healthcare]

Better Essays
1454 words (4.2 pages)

Essay about Business Analysis: Sloans Lake Managed Care

- In order for Sloans Lake Managed Care (SLMC) to go from being an organization whereby Health plans and self-funded employers paid Sloans Lake to have access to the panel of doctors and hospitals with which it had contracts and move to being a fully insured HMO, the organization would have to use an implementation strategy. First, by utilizing employee participation and a good communication plan the organization would create a behavioral model for how the business would respond to the shift in organizational strategy in order to achieve and maintain outstanding performance....   [tags: Business Analysis ]

Better Essays
1652 words (4.7 pages)

Essay on Bundling in Health Care

- Bundled Efficiency In the U.S. alone, more than 366,000 people diagnosed with end stage renal disease (ESRD) are dependent on kidney dialysis as their life sustaining therapy (Collins, Foley, Gilbertson, & Chen, 2009). The majority of these patients rely on costly in-center hemodialysis (HD) three times a week to filter their blood during four-hour sessions. Since 1972, Medicare had covered patients’ dialysis related costs along with the separately billed and frequently used medications that are part of the end stage kidney disease treatments....   [tags: Health Care]

Better Essays
1587 words (4.5 pages)

Essay on Description Of The Coverage Based On Dwelling

- description of the coverage based on dwelling, other structures personal property, and loss of use or actual loss sustained unless otherwise specified including personal liability for each occurrence along with medical payments to others, for each person and each accident. Additional coverage for insurance described as a standard mortgage clause means that without the protection of the mortgagee clause, financial institutions would unlikely loan large amounts of money necessary to purchase homes....   [tags: Insurance, Term life insurance, Health insurance]

Better Essays
1068 words (3.1 pages)

Job Description and Person Specification: Business Manager Essay

- Job Description and Person Specification BUSINESS MANAGER Job Identification Title: Business Manager Accountable to: Chief Executive and Registrar Reports to: Chief Executive and Registrar Location: 83 Victoria Street, London SW1H 0HW Salary: £42,000 per annum Contract: 6 month probationary period, after which the position will be reviewed against agreed objectives and made permanent, if satisfactory. Hours of employment: 35 hours per week from 9.00 am – 5.00 pm Line management: Registration & Website Officer, Finance Officer and Administrative Assistant (subject to change as the organization develops and increases in size) Job Summary To manage the operational business of the organizat...   [tags: job identification, duties and responsabilities]

Better Essays
957 words (2.7 pages)

Benefits Of Integrated Managed Care Essay

- Integrated Managed Care Organization- The organization is properly aligned for the primary driver being cost cutting services. Since all entities within the organization are responsible and affected by any expenses endured on any entity being unfavorable or favorable, the foundation serves as a primary motivator to reduce costs at all levels. This alignment eliminates any financial gains from driving high utilization of services or higher intensity services within the organization. Ultimately, this system allows the physician medical group to drive patient care, being responsible for the clinical care decisions as opposed to health plan making those decisions as designed in other organi...   [tags: Health care, Health insurance, Managed care]

Better Essays
957 words (2.7 pages)

Essay on Description of the Trial Scene from The Crucible

- Description of the Trial Scene from The Crucible The entire town of Maycomb is excited about the trial. However, this excludes the prejudice less people like Miss Maudie who doesn't want to see someone on a trial for his life. She considers it like a Roman Carnival. On the day of the trial, a vast crowd camps in the town square to eat lunch. They all have gathered to witness the incident that is about to take place. Jem, Scout and Dill also have come to see the trial. When the crowd starts to enter the courthouse, the children take this opportunity to their advantage to slip into the courtroom without Atticus noticing....   [tags: Essay on The Crucible]

Free Essays
1247 words (3.6 pages)

Managed Care Essay

- Managed Care Introduction Surprisingly, U.S. managed care has been in existence for almost a century. In 1910, the Western Clinic of Tacoma, Washington offered medical services through its network of doctors and nurses for the premium payment of $0.50 per member per month. Nearly one hundred years later, managed care organizations (MCOs) have changed dramatically with increased complexity and significance to the U.S. healthcare market. Aggregate revenues for MCOs in the S&P 500 index grew 30% in 2006 to $212.4 billion while earnings per share estimates are expected to increase by 15% for 2007....   [tags: Healthcare Managed Care]

Better Essays
1832 words (5.2 pages)