Cost-sharing and medical expenditures also have to do with population health issues with health plan coverage. People want affordable care with good quality for long-sustaining results. It doesn’t mean consumers won’t deal with burden of higher costs when plans change or the amount of health care treatment is steep with high out-of-pocket costs. The policy background illustrates a lot of the health care spending and plan coverage. They aim to shift health care costs from government and insurance companies into households, (Gould, 2013). Increased cost-spending and taxation have been subject to the policy proposals. This is why consumers have to be more informed about health plans and new changes. As policy proposals have been beneficial to…show more content… This can’t be done without the help of hospitals, administrators, and executives. True integration means aligning physician and hospital goals and giving physicians real decision-making and leadership roles, (Aston, 2013). Hospitals have the advantage to bring in specialists for certain disease specific treatment and procedures. There’s a lot of implementing and decision-making when it comes to choosing physician specialists because the costs and insurance rates are important to consider. The hospital and physician practices in prior decades are not the same today and it’s vital to uphold standards for patient safety, care, and medical costs. As (Medicaid.gov, 2015) states, by contracting with various MCO’s to deliver Medicaid program health care services to their beneficiaries, states can reduce Medicaid program costs and better manage utilization of health services. Most states are implementing and coordinating more traditional services for managed care. Medicaid will to rise and aiding people who live in poverty, but the amount of challenges that lie ahead are problematic. For instance, the types of services including long-term care, mental illness, and eligibility standards are not permissible for everyone. According to (Medicaid.gov, 2015), these benefits are dedicated on improving care for…show more content… Additionally, few of the many services are preventive, diagnostic, injection, immunizations, medications, health education, counseling, hearing, and vision. Moreover, when a primary care provider signs a tax or capitation agreement, a list of specific services that must be provided to patients is included in the contract, (Alguire, 2015). By gaining young physicians to fulfill these specific types of preventive practices is helpful and a constant need. This is why contract negotiating is so important and this source provides a detailed list of (PMPY), capitation rates, and services. The flipside to capitation rates is the amount of referrals exceeding cost rates which can put managed care facilities in financial turmoil.
Without capitation rates, managed care wouldn’t be able to stabilize costs. Capitation rates vary among different ages, categories, and withhold amounts. Also, capitation rates vary region to region so close proximity may be helpful, as opposed to different states further apart. Different rates and withholdings apply even Medicaid for those who are eligible to receive services. Primary care physicians must always be forward-thinkers when it comes to payments, services, hiring specialists, and continuing