Stephen P. Robbins and Timothy A. Judge in "Organizational Behavior", 12th ed. Upper Saddle River, New Jersey, 2005, p. 407
...he status of the healthcare system today indicate that managed care organizations actually play a very important role in the healthcare system and the care it delivers to beneficiaries and patients. Improvements in the quality of care continue to increase across the spectrum but while there is much to celebrate about, there is also a lot to work and better in. Partnerships and compromises among MCOs, hospitals, insurance companies, health plans, practitioners, consumers and purchasers must be made to fill in the gaps and fill the areas that are still far from perfected. Needless to say, the healthcare system will never reach complete perfection because it is an ever-changing industry that adapts and transforms through time, but if all the components joint and work together then the mission of providing every patient with the best care possible will be fulfilled.
Kreitner, R., & Kinicki, A. (2008). Organizational Behavior - 8th ed. New York: McGraw-Hill Irwin.
Managed care dominates health care in the United States. It is any health care delivery system that combines the functions of health insurance and the actual delivery of care, where costs and utilization of services are controlled by methods such as gatekeeping, case management, and utilization review. Different types of managed care plans came into development by three major factors. These factors include choice of providers, different ways of arranging the delivery of services, and payment and risk sharing. Types of managed care organizations include Health Maintenance Organizations (HMOs) which consist of five common models that differ according to how the HMO is related to the participating physicians, Preferred Provider Organizations (PPOs), Exclusive Provider Organizations (EPO), and Point of Service Plans (POS). `The information management system in a managed care organization is determined by the structure of the organization' (Peden,1998, p.90). The goal of a managed care system is to provide subscribers and dependants with needed health care services at the lowest possible cost. Certain managed care plans also focus on prevention by trying to keep members healthy.
Hill, M. A., Miller, C. C., & Colelle, A. (2011). Organizational Behavior. Hoboken: John Wiley & Sons Inc.
There are so many problems with our society’s health care. Everyone wants to find a
From 1910 - 1970, MCOs were a small part of the healthcare landscape (see Exhibit 1 for industry timeline). As increasing medical costs placed budget constraints on government programs, it was believed that the traditional way of delivering healthcare was financially wasteful since healthcare providers (doctors, hospitals, etc.) had no incentive to keep costs to a minimum. In 1973, U.S. Congress passed the Health Maintenance Organization (HMO) Act, which required all employers with greater than 25 employees to offer two federally certified HMO plans for its workers. Unfortunately for the industry, obtaining federal certification was not an easy process. Strict requirements pertaining to minimum benefit standards, quality assurance, and financial stability made it difficult for HMOs to comply. However, during the Carter and Reagan administrations (early 1980’s), issuance of the regulations became a priority and growth ensued.
Ivancevich, J. M., Konopaske, R., Matteson, M. T. (2009). Organizational behavior and management. Homewood, IL: BPI/Irwin.
The rapid growth of managed care is the response to limited financial resources and the demand for healthcare services to be affordable. Economic viability is a crucial aspect of health care. Managed care plans were developed to provided health care services, but also to be a method to collect payment for services. There are different types of managed care plans. For example, health maintenance organization (HMO), preferred provider organization (PPO), and point-of-service (POS) plans. For brevity of this paper the HMO managed care system will be discussed along with the relevance of the role of the advance practitioner practicing in HMO setting.
Robbins, S. P., & Judge, T. A. (2009). Organization behavior. (13th ed.). Upper Saddle River, NJ: Prentice Hall.
WellStar Health Systems is currently the preeminent and largest health care provider in Metro Atlanta. WellStar Health Systems is a not-for-profit institution that is composed of 5 hospitals and an abundance of physician groups. Physician specialty groups included within WellStar are: ENT, Psychiatry, Endocrinology, Pulmonary Medicine, Infectious Disease, General Surgery, Rehabilitation, Pathology, and Rheumatology. WellStar’s organizational design is composed of internal and external factors that define the organization’s size, organizational structure, and processes. Internal and external factors are the basis for influencing managerial conclusions in decision-making. These factors vary from organization to organization and are the rationale for understanding WellStar’s strengths, weaknesses, opportunities, and threats. Understanding these variables is a necessity for the sake of WellStar’s survival
Buchanan, D. A. , Huczynski, A. A., (2010) Organizational behaviour. 7th Edition. Essex: Pearson Education.
Robbins , Stephen P. and Judge, Timothy, A. Organizational Behavior. Upper Saddle River, New Jersey. Prentice Hall. Pearson Custom Publishing. 2008 Print