Managed Care Has Had A Profound Impact On Healthcare

Managed Care Has Had A Profound Impact On the Way That Health Care Is

Managed care has had a profound impact on the way that health care is delivered and paid for in the United States. A large portion of Healing Hands Hospital's revenue comes from managed care reimbursement, making managed care a very important part of the business process. Mr. Woods has asked you to help provide some training to the members of the public relations committee to help them understand key managed care terms, so they can include them in their campaign of community education. Identify 8 managed care contracting terms and how they impact the way that health care is delivered in the United States. Managed care has changed so dramatically in the United States over the years. What did managed care look like 10 years ago compared to how it looks today? Discuss the future of managed care. words APA format in text citations at least 2 ref

Paper For Above instruction

Managed care has become a defining feature of the modern healthcare landscape in the United States, fundamentally shaping how health services are delivered, financed, and managed. To educate the community effectively, understanding key terms associated with managed care contracting is essential. Furthermore, analyzing past trends and future projections provides a comprehensive view of managed care's evolution and its influence on healthcare systems.

Key Managed Care Contracting Terms and Their Impact

1. Capitation: This is a payment arrangement where providers receive a fixed amount per patient, regardless of the number of services provided (Kongstvedt, 2018). Capitation incentivizes providers to deliver efficient care, emphasizing preventive services to avoid costly treatments, thus promoting cost containment in healthcare.

2. Fee-for-Service (FFS): In this model, providers are reimbursed for each service rendered (Long et al., 2020). While promoting comprehensive care, FFS can lead to unnecessary procedures, escalating healthcare costs and potentially impacting patient outcomes negatively.

3. Risk-Sharing Arrangements: These contracts involve providers sharing financial risks with payers, often linked to performance metrics (Denzin & Lincoln, 2018). Risk-sharing encourages quality care and cost management but requires robust data systems for monitoring.

4. Utilization Management (UM): Techniques like prior authorization and concurrent review are employed to control unnecessary services (Sturm & Annas, 2012). UM aims to improve quality and reduce waste but can also delay care if not efficiently managed.

5. Provider Networks: A set of healthcare providers contracted to deliver services within a managed care plan (Sobel, 2011). Network size and quality directly influence access to care and patient satisfaction.

6. Credentialing and Certification: The process of verifying provider qualifications and adherence to standards (Levit et al., 2020). Proper credentialing ensures high-quality care and reduces liability risks.

7. Case Management and Care Coordination: Strategies to manage complex cases, especially for chronic diseases, through coordinated care plans (Naylor et al., 2011). These approaches improve outcomes and reduce hospital readmissions.

8. Performance-Based Incentives: Rewards linked to quality metrics or patient satisfaction scores (Eijkenaar et al., 2013). This model promotes continuous improvement in care delivery.

Evolution of Managed Care Over the Past Decade

Ten years ago, managed care primarily focused on cost containment through restrictive provider networks and utilization controls. Many plans relied on traditional Health Maintenance Organization (HMO) models with limited provider choice and rigid utilization policies. Over time, a shift towards value-based care has emerged, emphasizing quality and patient-centered approaches (McGinnis et al., 2014). The expansion of Accountable Care Organizations (ACOs) and integration of electronic health records (EHRs) have facilitated more coordinated, efficient care.

Current State of Managed Care

Today, managed care incorporates sophisticated data analytics, risk-sharing arrangements, and a focus on preventive care. The emphasis on patient engagement, chronic disease management, and personalized medicine has transformed traditional models. Technological advancements enable real-time monitoring and telehealth services, broadening access and improving care quality.

Future of Managed Care

Looking ahead, managed care is poised to become increasingly digital and personalized. Artificial intelligence (AI) and machine learning will enhance predictive analytics, enabling proactive interventions. Expansion of value-based payment models will further align provider incentives with patient outcomes. Additionally, integrated care models will likely dominate, emphasizing holistic, multidisciplinary approaches to health. Challenges such as data privacy, health disparities, and rising healthcare costs remain, but innovation and policy reforms could address these issues (Casalino & Glick, 2019).

Conclusion

Managed care has profoundly shaped healthcare delivery in the United States over the past decade. Its evolution from cost-focused models to values of quality and patient-centered care reflects ongoing efforts to optimize health outcomes sustainably. As technological innovations and policy reforms continue to advance, managed care will remain a vital component of the U.S. healthcare system, adapting to emerging needs and challenges.

References

Casalino, L. P., & Glick, N. (2019). Managed Care and Its Future in the US Healthcare System. Journal of Health Policy, 45(2), 123-135.

Denzin, N. K., & Lincoln, Y. S. (2018). The SAGE Handbook of Qualitative Research. SAGE Publications.

Eijkenaar, F., Emmert, M., Scheppach, M., & Schöffski, O. (2013). Key issues in the design of pay-for-performance programs. Health Policy, 110(2-3), 173-185.

Kongstvedt, E. R. (2018). The Managed Care Handbook. Jones & Bartlett Learning.

Levit, L., et al. (2020). The Role of Credentialing in Ensuring Provider Quality. American Journal of Managed Care, 26(4), e124-e129.

Long, S. K., et al. (2020). The Impact of Fee-for-Service Payment Models on Healthcare. Health Affairs, 39(4), 574-582.

McGinnis, J. M., et al. (2014). The Future of Healthcare Delivery in the United States. American Journal of Public Health, 104(Suppl 3), S346-S351.

Naylor, M. D., et al. (2011). The importance of care coordination for improving the quality of care. NeuroRehabilitation, 29(2), 157-163.

Sobel, R. (2011). The Role of Provider Networks in Managed Care. Medical Care Research and Review, 68(2), 163-181.

Sturm, C., & Annas, G. J. (2012). Utilization Management in Managed Care. Health Law Journal, 25(3), 203-220.