Question

The paper is due at the end of this two week learning plan. The paper should be 2 to 3 pages in length. The paper is due by Sunday midnight at the end of the second week of Learning Plan Five.

The assignment assesses competency 3. Analyze the broader implications of managed care for delivery of health care services, 6. Summarize the evolution of managed care, including the forces that have driven this evolution, 8. Interpret the effect of managed care on access to health care.

Directions: Review the following video: Medicaid and HMOs Video.
• Assignment: Should Medicaid and HMOs join forces?
• Write a 2 – 3 page paper in what you find out about whether or not the HMO’s representative claims were correct. Does an HMO, enrolling Medicaid patients promise; one, cost efficiency and two improvements in quality of care? One site you can get started is www.nber.org. There are many other sites you can look at to get data about this. So that’s your assignment. Good idea? Bad idea and why? Back it up with some good data. That’s all there is to it. Good Luck!”

Consider:
• Would the state save money by enrolling members in an HMO? How so?
• What would happen to the quality of care? Give possible examples. Cite your references.

Answer 1

The implications of managed care in delivering health services

The most common forms of managed care providers are Health Maintenance organisations(HMOs), Preferred Provider Organisations(PPOs) and Point of service plans (POS). The rapid growth of managed care has had many implications for patients,doctors,employers,state and federal programmes,the health insurance industry,major medical institutions, medical research, and vulnerable patient population.Managed care has accorded greater prominence to the assessment of patient satisfaction,profiling and monitoring of doctors' work, the use of clinical guidelines and quality assurance procedures and indicated the potential to improve the integration and outcome of care.

Coverage options-patients have a choice of three types of health plans with different co-payment rates.

Better drug costs-under managed care patients are spending less on their prescription drug bills

Restricted services-Patients in certain plans might not be able to easily see their preferred health provider,if that health provider works outside of the patients approved coverage network.

Referral issues--Before managed care,health providers referred patients for specialised medical sevices,without worrying whether th referred specialist is within their patient's health network.under managed care,now,patients have to decide whether to accept a specific referral.

Evolution of managed care

The origins of managed healthcare can be traced back to at least 1929 ,when Michael Shadid, a physician in Elk , City,Oklahoma ,established a health cooperative for farmers.Other major prepaid group practice plans were initiated between 1930 and 1960 which encountered strong opposition from the medical establishment, yet attracted a large number of enrollees.Public managed health care plans originated after the enactment of the health maintenance organisation act of 1973.The purpose of the legislation was to stimulate greater competetion withinhealth care markets by devoloping outpatient alternatives to expensive hospital based treatment.Healthcare costs however continued to increase,consuming approximately one tenth of GNP by1983.In an attempt to slow the growth rate,in 1982 hospital reimbursement rates were capped under the medicare program .Arizona became the first state to apply managed care principles to the delivery and financing of Medicaid-fundedLTSS in 1987.During the late 1980s and early 1990s managed care plans were credited with curtailing the runaway growth in healthcare costs.