The Importance Of Managed Healthcare

Managed healthcare is activities that work to reduce the cost of healthcare while improving the quality of care. In the United States, we have the most expensive healthcare system, but most Americans don’t take advantage or have benefits. Managed care continues to evolve with the constant change of the health insurance system. With managed healthcare, an emphasis is placed of preventive care and early intervention. These plans are most often known as restrictive but do contain cost. These plans do make it more difficult to receive specialized care though. Health Insurance and managed care are relatively new, as they just began to evolve in the 20th century. There are several types of payer and provider organizations, each is different

Within each organization, there is a unique governance and various aspects to be controlled. There may be state law and regulations that must be followed in certain organizations however that doesn’t apply to every organization. As well as structures that must be followed of national organizations much more than local ones. Accreditation has grown through recent years in POS plans, PPOs, and HMOs. States have also increased the requirement for accreditation for the state insurance department and Medicaid programs. The ACA also mandates for plans operating through the health insurance exchange be accredited. Utilization management is a term used by the system to reduce rather than negotiate prices. Utilization management plays a role is almost every aspect of a health care organization as well as health plans. There are three sections of utilization management; review of necessary services to be covered, facilitate needs at a reliable cost, and reducing unwarranted practice variations. Along with the managed care and health insurance, utilization management evolves. Health maintenance organizations and point of service plans have reduced utilization management