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 …show more content…
The Chromic Care Model (CCM) was developed to integrate more of a patient centered approach to medical symptoms. Often time when caring for patients it was the acute symptoms that took priority the management of reoccurring systems where over looked. The CCM model has help promote the development and implementation of easier access to care for behavioral health patients. According to the authors of the journal article Mental Health in ACOs: Missed Opportunities and Low Hanging Fruit the CCM has proven to be an effective method of making access to behavioral health easier. It has included mental health in to the primacy care sector making it easier to screen patients then follow up with them after. By allowing this in primary care it has identified 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
The culture of managed care for behavioral mental health is rapidly changing. In 2014, the American health care community saw new federal legislation requiring the inclusion of behavioral health in insurance plans (retrieved: http://www.nytimes.com/2014/01/10/your-money/understanding-new-rules-that-widen-mental-health-coverage.html?_r=0) . These legislations came at the heal of several debates about the gro...
Health Care Service Corporation. Serious Vs. Non-Serious Mental Illness. 10 August 2013. blueaccess. Web-site. 9 November 2013. .
Health Maintenance Organization (HMO) is a group of individual health plans that are intended to provide services for costumers’ that purchase insurance policies and for those that cannot afford health insurance. Many of these organization are led by physicians, and other professionals that network together to make health care affordable for patients. In the HMO category there are five separate managed care plan models. First, the Group Model (HMO), is a group that has a number of physicians that mainly agree to provide care to a defined group of patients in return for a fix rate capita payment for discounted fees from insurance companies (Henderson, 2012 p.212).
Each year, 52 million Americans have some form of mental health problem and out of those patients 60% are members of a managed care group. (Madonna, 2000, ¶ 8) Managed mental health care’s successes and failures now bear directly on the mental wellbeing of 32 million particularly vulnerable Americans. Initially managed care was intended to be a “comprehensive approach to healthcare that included balancing cost, quality, utilization, and access.” (Madonna, 2000, ¶ 23) In theory, this is an optimal approach to the delivery of health care and it has proven somewhat successful in the area of physical health, but it has not provided the same success in the area of mental health. Mental health is still being treated as a separate and less important aspect of health care despite the fact that some mental health disorders, such as schizophrenia, have shown higher success rates than those of common medical procedure, such as angioplasty. (Etheredge, 2002, ¶ 6)
The CPA is a care management process for people with mental health and social care needs, including managing associated risks. The CPA main elements are: Assessment, Care coordinator, Care planning, Review, Transfer and Discharge. The National Standard Framework for Mental Health introduced it to supply a framework for effective mental health care (DOH, 1999; DOH, 2008; Gamble, 2005). Under CPA, John may use an Advance statement to illustrate his personal preferences and what he would like to happen in regards to his personal and home life should they come to lack capacity. These are important mechanisms for safeguarding and promoting a patient’s interests and health. The CPA is grounded in values and principles that are central to personalisation brought about when in March 2008 ‘Refocusing the Care Programme Approach’ was issued. This updated guidance highl...
Health Maintenance Organizations, or HMO’s, are a very important part of the American health care system. Also referred to as managed care programs, HMO's are combinations of doctors and insurance companies that are formed into one organization. This organization provides treatment to its members at fixed costs and decides on what treatment, if any, will be given based on the patient's or doctor's current health plan. Sometimes, no treatment is given at all. HMO's main concerns are to control costs and supposedly provide the best possible treatment to their patients. But it seems to the naked eye that instead their main goal is to get more people enrolled so that they can maintain or raise current premiums paid by consumers using their service. For HMO's, profit comes first- not patients' lives.
Essay question 1: Critically discuss the biomedical model and social model of health and how they relate to lay perspectives on health and illness.
In the United States alone, 57.7 million individuals suffer from mental illness. These illnesses range anywhere from mood disorders to anxiety disorders or to personality disorders and so on (The Numbers Count: Mental Disorders in America). 18 to 25 year olds make up about 30% of these individuals alone (Survey Finds Many Living with Mental Illness Go Without Treatment). These individuals require care from medication to psychiatry or even to confinement. However, of these 57.7 million individuals with mental illness, studies have found that less than one in three of these individuals receive proper treatment (Studies Say Mental Illness Too Often Goes Untreated).
What is managed care? According to the Oxford English Dictionary, managed care is “a system of health care in which patients agree to visit only certain doctors and hospitals, and in which the cost of treatment is monitored by a managing company.” Managed care is a variety of techniques designed to reduce the cost of providing health benefits and advance the quality of care. In the United States alone, there are various managed care programs, that are ranged from more restrictive to less restrictive. As stated in the National Institutes of Health, the future of managed care is uncertain. It is enthralling to note that in spite of the advances in healthcare systems, such as our hospital’s ability to provide patients with lower cost, managed
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.
In practice, there are other assessment tools such as….which I could have used but the CPA is a recommended National Standard Framework for Mental Health, introduced in 1991, to supply a framework for effective mental health care (DOH 1999; DOH 2008) and to safeguard all service users (SU) by appropriate assessment and review (Gamble, 2005). But it is time consuming, in practice and paperwork. Service users’ participation has been repeatedly disappointing; studies constantly report little awareness of the CPA policy (CPAA, 2006; McDermott, 1998).
For mental health disorders, there is a huge emotional and financial burden for individuals, families, and society. The economic impacts
Managed health care actually combines health care delivery with the financing of services provided. This was intended to replace conventional fee-for service plans with much more affordable quality of care to the health consumers as well as the providers who was in agreement with the restrictions. However, managed care is becoming challenged due to the growth of consumer-directed health plans, which defines employer continuations and asking employees to be more responsible within their health care decisions and cost-sharing. The Americans health care system has been changing the way their health care services are organized and delivered. As seen by the movement from traditional fee-for-service systems to managed care networks. Ranging from structured staff model HMOs to the lesser structured preferred provider organizations (PPO). Statistics show that 60 million Americans are enrolled with some type of managed care program within the response to regulatory initiatives which affect health care cost and quality. Managed care organizations are responsible for the health of their enrollees, which can be administered by a physician’s group, health system, or even a hospital. Much of the managed care financing is through a method called capitation, and the enrollees are assigned to a select primary care provider, which serves as a gatekeeper.
...se of mental health services through health reform (2006). Many mental disorders can be treated effectively and people do recover (2010, 09 06). Many times mental disorders go untreated and it is very important that family and friends don’t let this go ignored and seek help for their loved ones.
The program will aim to measure its performance and will assess for service capacity, flexibility and delivery of services. The clinic will provide client questionnaire cards after every consultation in order to better assess for client satisfaction. The client questionnaire will focus on quality of service, recommendations, and treatment satisfaction. The questionnaires will be reviewed weekly and be look upon as an important tool for client input and overall program improvement. Internally the team along with the supporting staff will conduct a self assessment by using the Behavioral Health Integration Capacity Assessment (BHICA) that is aim at measuring service delivery and will help evaluate the program’s ability to implement integrated