study, many beneficiaries reported a less positive experience when assigned to a managed care plan. In addition the author of the article should have elaborate more about the Medicaid managed care plan on people with disabilities and how it works. The article is more focus on the guiding principles created by the National Council on Disability. c. What innovation is needed? In order to effectively implement the managed care delivery system in the country, Medicaid managed care organization should plan new strategies that minimize barriers, embrace new technologies, and create incentives for providers to deliver cost-effective, patient centered care. Some of the innovative strategies are (1) New ways of working with and paying providers to …show more content…
The positive impact of managed care plan to Medicaid beneficiaries is that it has the potential to improve the quality of care as managed care promises care coordination and improved attention to primary care services, both of which are largely ignored in fee-for-service systems. On the other hand, the negative impact if managed care plan to Medicaid beneficiaries occur when it is not effectively implemented and well designed. The aim of Medicaid managed care to control cost can have an adverse impact on people with disabilities, whose chronic conditions may require expensive surgeries, adaptive equipment, and ongoing or ancillary …show more content…
Today, more than two-thirds of the 70 million Medicaid beneficiaries receive at least a portion of their services through a managed care plan. Until recently, the vast majority of these enrollees have been people without disabilities, however, now more than half the states are enrolling adults with disabilities as well as children with specialized medical needs. In addition, the number of States utilizing Medicaid managed care for long-term services and supports jumped from 8 in 2004 to 16 in 2012. This trend will undoubtedly increase as the as the Affordable Care Act expands Medicaid eligibility and the decline of health care
To guarantee that its members receive appropriate, high level quality care in a cost-effective manner, each managed care organization (MCO) tailors its networks according to the characteristics of the providers, consumers, and competitors in a specific market. Other considerations for creating the network are the managed care organization's own goals for quality, accessibility, cost savings, and member satisfaction. Strategic planning for networks is a continuing process. In addition to an initial evaluation of its markets and goals, the managed care organization must periodically reevaluate its target markets and objectives. After reviewing the markets, then the organization must modify its network strategies accordingly to remain competitive in the rapidly changing healthcare industry. Coventry Health Care, Inc and its affiliated companies recognize the importance of developing and managing an adequate network of qualified providers to serve the need of customers and enrolled members (Coventry Health Care Intranet, Creasy and Spath, http://cvtynet/ ). "A central goal of managed care is containing the costs of delivering care, but the wide variety of organizations typically lumped together under the umbrella of managed care pursue this goal using combination of numerous strategies that vary from market to market and from organization to organization" (Baker , 2000, p.2).
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
In December 2011, Texas Health and Human Services Commission (HHSC) received federal approval of a Medicaid Section 1115(a) Demonstration Waiver, entitled “Texas Healthcare Transformation and Quality Improvement Program,” for the period starting with December 12, 2011 through September 20, 2016. The main objective of the 1115 Waiver is to improve access to and quality of health care by expanding Medicaid managed care programs and promoting health care delivery system reforms while containing cost growth. Specifically, the Waiver created two new pools of funding—Uncompensated Care (UC) and Delivery System Redesign and Innovation Payment (DSRIP) pools—by redirecting funds that were available under the old Upper Payment Limit (UPL) payment methodology. DSRIP funding is used to offer financial incentives to health care providers that develop and implement projects aimed at improving how care is delivered to low-income populations. Specifically, the providers (often referred to as the “performing providers” or “performers”) propose and execute projects like programs, strategies, and investments designed to enhance access to health care, quality of health care, cost-effectiveness of services, and health of the patients and families served.
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. This would fall into the category of management of utilization, if hospitals and managed care organizations can control treatment utilization, they can control premium costs for both themselves and their customers (Rodwin 1996). If health care organizations can implement prevention as a way to warrant good health with their consumers, insurance companies can also illuminate unnecessary health care. These are just a few examples of how the health care industry can help benefit their patients, but that does not mean every issue involving physician over utilization or quality of care is erased because there is a management mechanism set in place.
In Texas, most Medicaid services and all Children’s Health Insurance Programs (“CHIP”) services are delivered through managed care. The Texas Health and Human Services Commission (“HHSC”) contracts with state-licensed managed care organizations (“MCOs”), and pays them a monthly amount to coordinate health services for Medicaid or CHIP members enrolled in their plans. The MCOs contract
According to the article “Medicare Made Clear” published by United Health, “the Medicare program helps 43 million Americans get the health care they need.” The large number of Americans being helped by Medicare shows that it is important and very much needed. Being knowledgeable on the topic of Medicare and Medicaid and knowing the different aspects of the programs will be useful for many Americans.
The current health care reimbursement system in the United State is not cost effective, and politicians, along with insurance companies, are searching for a new reimbursement model. A new health care arrangement, value based health care, seems to be gaining momentum with help from the biggest piece of health care legislation within the last decade; the Affordable Care Act is pushing the health care system to adopt this arrangement. However, the community of health care providers is attempting to slow the momentum of the value based health care, because they wish to maintain their autonomy under the current fee-for-service reimbursement system (FFS).
Implemented (along with Medicare) as a part of the Social Security Amendments of 1965, Medicaid’s original purpose was to improve the health of the working poor who might otherwise go without medical care for themselves and their families. Medicaid also assisted low income seniors with cautionary provisions that paid for the costs of nursing facility care and other medical expenses such as premiums and copayments that were not covered through Medicare. Eligibility for Medicaid is usually based on the family’s or individual’s income and assets. When the ACA came into effect in 2010, it began to work with the states to develop a plan to better coordinate the two ...
In order to make ones’ health care coverage more affordable, the nation needs to address the continually increasing medical care costs. Approximately more than one-sixth of the United States economy is devoted to health care spending, such as: soaring prices for medical services, costly prescription drugs, newly advanced medical technology, and even unhealthy lifestyles. Our system is spending approximately $2.7 trillion annually on health care. According to experts, it is estimated that approximately 20%-30% of that spending (approx. $800 billion a year) appears to go towards wasteful, redundant, or even inefficient care.
Managed care reimbursement models have contributed to risk avoidance by negotiating discounts, discouraging use, and denying payments for charges that appear to be false. Health care reform has increased awareness to the quality of care providers give, thus shifting the responsibility onto the provider to provide quality care or else be forced to receive reduced reimbursements (Buff & Terrell,
Clearly, the Medicaid program is ripe for a major overhaul, a task that the federal government has thus far been unwilling to undertake. I chose this topic because I believe that the Medicaid program can be rescued and revitalized by leadership; otherwise, it is likely to be eroded. Medicaid is a government-sponsored program whose objective is to provide patients with health assistance upon meeting specific criteria. Medicaid is an insurance program that is available for disadvantaged persons, including the elderly, who cannot afford health benefits because of low incomes or other factors. This program is subsidized by government funds and in many instances, will cover the costs of basic medical care as well as specialized testing and supplies. What are the problems with Medicaid and what should be done about them? This paper will look at 6 articles about the economics of Medicaid and analyze what should be done about this problem.
What is the broader implication of managed care for health care services is how healthcare providers control health care cost and quality care. With all the competition to pick from and the rising cost of health care the consumers’ needs to look at all options available. The keys to manage care are the types of organizations and insurance options that include health (HMO’s) maintenance organizations, provider organizations PPO’ and POSS. The health insurance industry is big on wellness and prevention as part of managed care.
Reforming the health care delivery system to progress the quality and value of care is indispensable to addressing the ever-increasing costs, poor quality, and increasing numbers of Americans without health insurance coverage. What is more, reforms should improve access to the right care at the right time in the right setting. They should keep people healthy and prevent common, preventable impediments of illnesses to the greatest extent possible. Thoughtfully assembled reforms would support greater access to health-improving care, in contrast to the current system, which encourages more tests, procedures, and treatments that are either
As a result, a growing number of Medicare and Medicaid recipients were transferred into capitated or fixed payment plans to save on costs, but this created a problem in the collection of data because under the fee-for-service plans Medicare was the largest payer of services provided by home health care agencies at 44 percent; Medicaid came in a close second at 38 percent; private insurance and other third-party payers made up 10 percent; and the final 8 percent came from patients who paid directly out-of-pocket. Capitated plans limit the ability to collect data on home health care services because the physician is given one flat fee per the number of patients covered regardless of how many patients he actually provides services to. This makes it difficult to document the specific services provided to the patient, thus making it difficult to justify the need to expand and modify the current program. Another reason data for home health services is so difficult to track is, Medicaid programs in fifteen states have implemented self-directed services which permit patients to coordinate their own home health services and compensate family members who provide care. The implementation of self-directed services in these fifteen states have had positive results in decreasing the amount of unmet patient’s requirements and enriching health outcomes, quality of life, and beneficiary satisfaction at a rate equivalent to that of the traditional home health agency directed service
Finding affordable, quality care in the U.S. is difficult. The uninsured population in the U.S. is about 48 million. If these people cannot find affordable care in the U.S., they will find creative ways to receive it. In addition, the increase in co-payments, deductibles, and insurance premiums is pushing people towards find...