Description Of A Managed Care Essay

Description Of A Managed Care Essay

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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...


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...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.

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