Managed Care

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Managed care is simply a system that delivers health care to a specific population purchased through health insurance plans. Practitioners and providers manage the use of health care services and cost by providing effective diagnosis and treatment, appropriate use of inpatient and outpatients facilities, population-based planning, health promotion and education, and disease prevention. Managed care uses a “gatekeeper” system, where patients or beneficiaries are assigned a Primary Care Physician (PCP), who they see initially for all medical care. The PCP acts as a gatekeeper by initiating referrals to specialists when required and approving inpatient admissions. Managed care was seen across communities in America as early as the 19th century and by 1938, Henry Kaiser had adopted a pre-paid medical plan for his employees. During World War II Kaiser used pre-paid medical programs for his workers and after the war he opened these plans to the public, which became the Kaiser Permanente we know today. Pre-paid healthcare and Health Maintenance Organizations (HMOs) came into full use in the 1970’s when the federal government established grants and loans as part of a health care strategy to provide care for uninsured Americans by increasing the number of HMO, increasing enrollment, and containing the cost of healthcare. Since the 70’s employers have used managed care as a form of high quality low cost insurance for their employees and the federal government has turned to managed care for both Medicare and Medicaid programs. Managed care, managed care has become the dominant health care delivery source. Gaining popularity in 1990s, managed care increased from 27% in 1988 to 99% in 2009 and enrollment in Fee for Service plans decli... ... middle of paper ... ...ystem have started implementing or planning for a resurgence of Medical Home, using a primary care physician and a team of health care professionals providing or facilitating health care to a group of patients (Meyer, 2009). Medical home has proven to provide cost savings to the HMOs that employs the concept, Illinois Health Connect saved 140 million dollar in 2009 for the state by enrolling state Medicaid patients into the program (Japsen, 2010). Managed care needs to refocus on what made it successful in the beginning and using healthcare reform as a reason to change move to the next phase of managed care, medical homes. Will managed care survive? If plans remain flexible, continue to provide quality service, and remain low cost yes but if they continue to become more like the antiquated insurances plans they nearly drove to extinction then the answer is NO.
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