Managed Care Essay

Health is the fundamental need of human beings and thus, must be provided in the best way as well as manageable packages. However, cost, accessibility and effectiveness plays vital role in designing the best healthcare system. Consumers are on the lookout for a healthcare system they can manage effectively. In the US, the healthcare system is on the process of being reorganized because of the introduction of the Obama Care bill among other strategies. One major focus of the healthcare sector is managing cost and thus the need of implementing strategies for managed care. Managed care got its nod in the US after the introduction of the healthcare maintenance organization Act in 1973 (Linsley & Morton, 2014). The managed care system thereafter expanded, but its impact has been received with mixed results. Some have criticized it for its role in providing affordable healthcare cost, whereas other has lauded the initiative for its effort in making the healthcare affordable. With current efforts of ensuring that the Obama Care is implemented to the latter one can hardly predict the future of the managed care. This paper will endeavor to foretell the future of the managed care based on the current strategies in place. Managed Care Essay.

Managed Care

Managed care is a healthcare term mostly used in the US. It implies a number of techniques aimed at reducing the cost of healthcare benefits’ provision. Managed care is provided as a package to organizations using these techniques or at an agreed fee as a service to other organizations. The organizations that demands for this services are called managed care organizations (MCO). The managed care can also be described as a healthcare system in finance and deliver healthcare to those enrolled and organized around a managed care. The aim of managed care is to eliminate unnecessary costs in the provision of medical care. This is attained through various strategies including providing incentives to caregivers and healthcare consumers to select less expensive care, reviewing medical requirement of some medical services, and controlling the admission of inpatients among others. These programs are offered in various settings, including in organizations preferred by the provider and healthcare maintenance organizations (Greene, 1997).

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In 1973, the US government enacted the health maintenance Organization Act that sparked the growth of managed care. Techniques for managing care were introduced by healthcare maintenance organizations and managed by the same organization. However, several private organizations are currently using them. Their use has been enhanced in the 21^st century even though programs provided have attracted mixed results. Currently, managed care programs are ubiquitous in the US, and have managed to control the cost of healthcare to a certain extent (Fang & Rizzo, 2008).

The Future of Managed Care

Based on the current situation of the managed care, it is evident that the managed care is here to stay, and no attempt is in place to eradicate the plan. One issue in the contemporary generation is the cost of providing healthcare services to the people. Those who pay healthcare bills, including patients, governments, and employer groups  consider healthcare bills as burdensome and thus will welcome efforts to ensure the burden is made light (Fang & Rizzo, 2008). In this case, managed care will be looked upon to provide the necessary impetus to ensure the cost is lowered. At the same time, managed care organizations will tailor their services to ensure they are more focused on the consumer needs, and thus there are many aspects of the managed care in relations to its future as explored in this section.

The Future of Managed Care and Patient Care Needs

Although managed care is focused on ensuring reduction in the cost of the care, future efforts will focus on needs of the patient. In this case, managed care will be focused on the quality of the care. In this case, managed health care quality will be focused on addressing such factors as whether or not patient’s healthcare needs and even preferences are being met.

Focusing on the requirements of the patient is an aspect of quality, and this is the direction, which the future of the managed care will take. Managed Care Essay. In the current market trend, buyers of healthcare packages are concerned on indicators of quality in healthcare. The process has become sophisticated and thus the sophistication will be heightened in the future (Fang & Rizzo, 2009). This means differentiation of service providers on the market will not only be based on the cost of the service alone rather on other issues that include quality. This means the best deal for managed care will not be on the lowest price, but rather on a mixed of services that demonstrate quality. In this case, a product with the highest value will win the market. This value will be based on the ability of managed care service provider to come up with quality improvement plans, as well as demonstrate a record of accomplishment in demonstrated quality.

Competition based on the quality will demand commitment from both the organization, as well as resources provider to ensure quality. A solo practitioner cannot manage quality in the managed care system because of the resources involved (Fang & Rizzo, 2009). Since the public will continue to push for quality in the healthcare system, managed care providers will continue to focus on quality to be at par or above the fee-for-service system.

The quality of the healthcare will be assessed through a number of parameters. In the first place, focus will be ensuring that the care is right for the illness. Illnesses come in various forms, and each demands a special care and attention. As a result, health care must be designed to target a specific illness rather than providing a trial-and-error package (Rodwin, 2010). In this case, the future of the managed care will aim at defining various health packages for each special need. For instance, the aged, the children, and people with disabilities can be given special care to target illnesses that affect them. In addition, specific illness among the mentioned groups to include obesity, high blood pressure among others that affects people in various groups can be given special attention.

Managed care will also focus on ensuring that the care is timely. Although currently the issue of speed in healthcare delivery is being considered, speed is likely to be an issue in future because of the increase in population (Rodwin, 2010). In this case, more people will be on the lookout for healthcare and thus speed will be of the essence. Ensuring speedy services will be paramount to the quality of delivery in the healthcare system, and thus it will be an important competitive tool.

Currently, managed care is ensuring that unnecessary test and procedures are not ordered as a strategy for reducing the cost of healthcare. In the future, such trend is supposed to remain and will focus on quality rather than cost-effectiveness. Some tests can affect the patient even if they are offered free. For instance, continued radiological scans can be dangerous to the body, and thus one must devise ways of reducing such tests (Smith, 2013). Such reduction will be of great benefit to the patient in terms of ensuring the overall quality of the healthcare package being offered on top of the cost.

Provider Contracting

Provider contracting is a common practice in the current managed care service strategies. It refers to a situation when doctors and healthcare practitioners have a contract through another payer to acknowledge a precise payment for services granted to patients. In managed care practice, the contract is drawn between the physician and other healthcare practitioners; on one hand and managed care organization on the other hand. The provider is accessed to various reimbursement schemes, including withholding, capitation bonuses, and discounted fee-for-service. In this scheme, a doctor is given a given amount of money to manage the patient for a given time, which is mostly annual. Managed Care Essay. For instance, in California, doctors are given between $35 and $50 monthly to manage one patient. The doctor is supposed to provide all the services needed by the patient for one month using that amount (Smith, 2013). If the expenses increase, the patient benefits, but the doctor loses.

Provider contracting is one of the strategies for ensuring cost effectiveness in the healthcare provision. However, it places the patient to the risk of quality (Smith, 2013). Since the doctor is restricted in terms of the budget to spend on the patient, he or she may restrict the services to within that budget, thereby influencing negatively on the patient. At the same time, doctors are tied to the contract, and this is likely to affect those willing to join the system.

Based on the problems associated with provider contracting, the future of the managed care is likely to witness mixed revolutions in the process or a reduction in the provider contracting in absence of timely revolutions. In the first place, the content of contracts is likely to change to include flexible options for physicians, such that they are not tied permanently. In addition, a number of viable options, such as spillover management are likely to emerge (Elliott et al., 2013). In this case, any funds below or above that allocated is likely to be pushed to the following month or period.

Cost Management Deals

Managed care mainly involves containing the cost of medical care. It was introduced to manage cost through a number of strategies. The managed care in the future is also expected to focus on cost management, with an improvement on the current strategies to involve quality. In the current healthcare market, many individuals and entities have designed and implemented cost containment products as an endeavor to trim down the cost of health care. These products have piled pressure on hospital facilities, physicians, and other providers (Pelletier et al., 2014). Nevertheless, the final goal is to reduce the cost of healthcare and thus focus managed care is on ensuring cost containment.

Currently, cost containment deals are focusing on a thorough review of the existing products and coming up with optimum cost that can be afforded by the common person. The future of cost containment deals is not likely to shift from the current trend (Pelletier et al., 2014). Cost Containment deals will focus on managing business costs within a given budget while limiting expenses to meet the financial target.

Effects of managed care on Medicare and Medicaid

Medicaid is a health insurance scheme for the public with low income. It was introduced to ensure that every individual has access to the medical cover in the US. By the conclusion of 2008, about 60 million Americans had been covered under the Medicaid. The current efforts are aimed at ensuring that all the Americans with an income of 133% below the poverty level are covered. It approximated that about 19 million uninsured Americans will have been ensured by 2019. From the analysis of the Medicaid programs, it is evident that the program is costly given the huge number of people who have been enrolled into the scheme. To ensure cost effectiveness, Medicaid is offered in managed care packages. According to a study by Ly and Glied (2014), about two-thirds of Medicaid beneficiaries receive their Medicaid packages through managed care. With the implementation of the Obama care plans; there have been a growing demand for Medicaid that is offered in managed care. Managed Care Essay. As a result, the scheme is currently referred to us Medicaid managed care (MMC).

Medicaid managed care has spread through almost every state in the US. In a survey carried in 2010, it was discovered that only Wyoming, New Hampshire, and Alaska states had not implemented MMC. MMC is being effected through contracts to managed care organizations (MCOs), as well as through PCCM or Primary care Case management (Linsley & Morton, 2014). With the current focus on ensuring that Medicaid covers every American with low income, the future of managed care is bright.

The use of managed care in Medicaid will increase as the Obama care plans continue to be unveiled. The government is focusing on reducing the cost of healthcare because of budget pressures. In this case, the US government will look for the available strategies for cost reduction. One way of reducing cost is through managed care programs and thus the program is likely to be given a new structure. Medicare, which is also a state funded program, will follow the same route as Medicaid in terms of cost reduction (Linsley & Morton, 2014). In this case, both Medicare and Medicaid will be provided through managed care packages. Effects on Medicare, as well as Medicaid in managed health care are moving in a direction where both recipients will be registered in some managed health care plan in the future. In this case, a new structure involving Medicare and Medicaid packaged under managed care will be unveiled.

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The Future Role of the Government

The government remains the central instrument in the management and provision of healthcare programs. The introduction of the current strategies was because of the introduction of new policies by both the state and central governments. The federal government has been central in providing funds, as well as guidance, but there have been no active legislation other than the famous Obama care plans. Since Medicaid is provided through managed care, the future role of the government in managed care is likely to be the same role as that played by the government in Medicaid. The current concern in the healthcare industry is the power of patients. Currently, patients have very little powers in the managed care, and thus focus is likely to be on ways of increasing patient’s rights (Linsley & Morton, 2014). The government is likely to come in with a number of legislation to increase the rights of the patients. The patient’s rights are likely to focus on ways of ensuring quality of the healthcare, which will be impacted by the increased managed care cost effectiveness deals. Managed Care Essay.

After the introduction of managed care into the federal government controlled Medicaid and Medicare, many insurance companies are rushing into the market to introduce managed care packages. However, the new entrants have little experience in managed care and this is likely to impact on the quality of their services. As a result, the future role of the state and federal government in managed care is likely to increase as a way of curbing inefficiencies. One way is through ERISA and HIPAA health care policies, which is represents, the government’s future role in healthcare regulations. Trough ERISA, the government will empower consumers to chose a plan that is important (Kongstvedt, 2007). ERISA will require that MCOs provide consumers with compressive information about their healthcare package before allowing them to operate (Linsley & Morton, 2014). ERISA is thus likely to act as a watchdog for the managed care implementations.

 Recommendations

Based on the information given on managed care, the future is full of mixed results; both positive and negative. As a result, there is a need for proper considerations to ensure that the program is well managed, and this will mean each party playing its part as recommended in this section.

• Physicians should seek for legal counsel before signing any provider contracting agreements. The legal counsel will ensure that such contracts do not tie them to a system that will exploit them.
• The Federal government ought to focus on increasing the rights of the patient. This will ensure that the patient remains at the control of quality as a way of curbing the exploitation.
• Managed care organizations should package their products based on the quality rather than cost alone because this will ensure competitiveness.
• Managed care organizations should also expand their capacities to take up the available Medicaid and Medicare opportunities available in the US.
• The state as well as federal governments ought to put in place measures to scan new entrants into managed care to ensure that they have the standard requisites to serve the consumers.

Conclusion

Managed care is an essential aspect in the current market, whereby focus is on cost effectiveness in the provision of healthcare packages. Managed care has resulted in the introduction of techniques aimed at lowering the cost of healthcare benefits provision. Managed care is provided as a package to organizations using these techniques or at an agreed fee as a service to other organizations. This paper has examined its future based on its present position in the US market. From the analysis, it has been discovered that managed care has a future in the US healthcare market. However, this will rely on the way it differentiates itself on the market. In this case, it should differentiate based on the quality rather than cost alone. At the same time, it should expand its capacity to occupy the available Medicaid and Medicare opportunities available. Managed Care Essay.