Explain The Growth Of Managed Care That Began In The 1980s ✓ Solved

Explain The Growth Of Managed Care That Began In The 1980s As A Resul

Explain the growth of managed care that began in the 1980s. As a result, how has health care delivery evolved? What role do hospitals have in advancing continuous quality improvement (CQI) health outcomes and modernizing U.S. healthcare delivery models? Based on the literature, what does the future hold?

Paper For Above Instructions

The concept of managed care emerged prominently in the 1980s as a response to the skyrocketing costs of healthcare in the United States. The growing complexity of the healthcare system, combined with the need for more efficient service delivery, led to the creation of various managed care organizations (MCOs). Managed care refers to a variety of techniques intended to reduce the cost of providing health benefits and improve the quality of care by overseeing the process of care delivery (Lichtenstein & Smith, 2018). This paper explores the growth of managed care, its impact on healthcare delivery, the vital role of hospitals in advancing continuous quality improvement (CQI), and future trends in U.S. healthcare models.

During the 1980s, several factors contributed to the expansion of managed care. The rising expenses associated with traditional fee-for-service (FFS) healthcare systems created a need for alternative models. Managed care systems aimed to provide cost-effective care while maintaining quality standards. By offering structured plans that limited patients to a specific network of providers, MCOs could negotiate better rates with healthcare professionals and hospitals. The Health Maintenance Organization (HMO) act of 1973 further catalyzed this movement by encouraging the formation of HMOs, which offered preventive care and comprehensive health services (Huang et al., 2019).

The growth of managed care significantly altered health care delivery by emphasizing preventive care, case management, and coordinated services. Providers adopted a more proactive approach to patient care, focusing on early intervention and chronic disease management. This shift not only improved health outcomes for patients but also reduced healthcare costs by preventing more complex conditions requiring expensive treatments (Bohmer, 2016). In addition, the integration of technology into managed care frameworks facilitated better communication and data sharing among healthcare providers, ultimately enhancing patient care.

Hospitals play a crucial role in advancing CQI and modernizing healthcare delivery frameworks. As institutions that provide both emergency and long-term care, hospitals are often at the frontlines of quality improvement initiatives. They implement structured programs aimed at enhancing patient safety, reducing readmissions, and ensuring compliance with regulatory standards (Shapiro, 2020). By establishing interdisciplinary teams and focusing on evidence-based practices, hospitals can foster a culture of continuous improvement and accountability in healthcare delivery.

One example of CQI in action is the use of clinical pathways, which are standardized treatment protocols designed to streamline patient care processes. These pathways help ensure that patients receive appropriate, evidence-based care while also minimizing unnecessary interventions. Studies have shown that hospitals employing clinical pathways experience improved patient outcomes and greater efficiency in resource utilization (Griffith et al., 2019).

Furthermore, the integration of technology and data analytics in CQI processes allows hospitals to monitor performance metrics actively, identify emerging trends, and implement targeted interventions (Menachemi & Collum, 2011). Hospitals can harness data to enhance decision-making, ultimately leading to improved patient outcomes and satisfaction. This is in line with the biblical principle found in Proverbs 24:3, which states, “By wisdom a house is built, and through understanding, it is established.” Just as a wise builder considers all factors in construction, hospitals must utilize data and insights to build a robust healthcare system.

Looking to the future, the evolution of healthcare delivery models has drawn attention to several trends influenced by managed care principles. The increasing focus on value-based care is shifting the paradigm from volume to quality, encouraging providers to emphasize patient outcomes rather than the quantity of services delivered (Porter, 2010). This approach incentivizes providers to invest in preventive care, holistic treatment methodologies, and care coordination, which align with the overall goals of managed care.

The rise of telemedicine, accelerated by the COVID-19 pandemic, is another important trend that exemplifies the growth of managed care. Virtual consultations and remote monitoring allow for greater access to care while maintaining cost-effectiveness (Barrett et al., 2020). As healthcare systems grapple with the challenge of providing care in a post-pandemic landscape, innovations like telehealth are likely to become integrated into the fabric of managed care models.

In conclusion, the growth of managed care since the 1980s has ushered in significant changes in healthcare delivery across the United States. Hospitals play an instrumental role in promoting CQI and adapting to evolving healthcare models, thus enhancing patient outcomes and optimizing resource utilization. The future of healthcare will likely continue to embrace these principles, focusing on value-based care and leveraging technology to improve the delivery of services. Through continuous assessment and adaptation, the healthcare system can work towards achieving its goal of providing high-quality, affordable care for all.

References

  • Barrett, C., Ray, S., & Qureshi, A. (2020). The rise of telemedicine in the COVID-19 era: How it’s changing healthcare delivery. Journal of Health Services Research & Policy, 25(4), 211-214.
  • Bohmer, R. M. (2016). The future of healthcare delivery: A new model to improve quality and reduce costs. Health Affairs, 35(3), 491-495.
  • Griffith, J. R., & White, K. R. (2019). Evidence-based care and clinical pathways: The essential role of hospitals. Journal of Healthcare Management, 64(1), 55-68.
  • Huang, J., Lin, L. L., & Kim, S. K. (2019). Managed care: Historical perspectives and future directions. Journal of Management, 45(2), 234-250.
  • Lichtenstein, R., & Smith, K. (2018). Managed care: The evolution of healthcare delivery models. American Journal of Managed Care, 24(5), e148-e153.
  • Menachemi, N., & Collum, T. H. (2011). Benefits and drawbacks of electronic health record systems. Journal of Medical Systems, 35(4), 717-722.
  • Porter, M. E. (2010). What is value in health care? New England Journal of Medicine, 363(26), 2477-2481.
  • Shapiro, J. (2020). Continuous quality improvement in hospitals: Strategies for success. Journal of Hospital Administration, 8(3), 62-70.

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