Watch The Following Videos In Preparation For This Assignmen

Watch The Following Videos In Preparation For This Assignmentny State

Watch the following videos in preparation for this assignment: NY State of Health (2016, January 12). Health Insurance Explained [video]. H. S. Rexburg (2016, October 19). Accreditation of health care [video]. Use what you learned from the videos, the module’s required readings, and your own research to answer the following questions. What is managed care and how did it evolve? Discuss the current state of managed care in the U.S. health system. Describe two efficiencies and two inefficiencies in managed care. Why is it important for policy makers and health care managers to understand the intricacies of the health care delivery system? Briefly describe some impacts of health care reform initiatives on managed care in the U.S.

Paper For Above instruction

Managed care is a system of health care delivery designed to improve quality while reducing costs through coordinated and comprehensive care management. It emphasizes the integration of health services for covered individuals to enhance efficiency and patient outcomes. The evolution of managed care dates back to the 20th century, beginning with health maintenance organizations (HMOs) in the 1940s and 1950s, which aimed to control health care costs by regulating access and spending. Over time, managed care expanded to include preferred provider organizations (PPOs), point-of-service (POS) plans, and other models that offered more flexibility but continued to focus on cost containment and quality improvement. The development was driven by rising health care costs, technological advances, and the need for system efficiency, leading policymakers and providers to seek strategies that balance cost, access, and quality.

Currently, managed care dominates the U.S. health system, especially in employer-sponsored insurance and Medicaid programs. Its approaches include network restrictions, utilization review, preventive care emphasis, and contracted provider arrangements. These strategies aim to manage costs while maintaining or improving healthcare quality. The shift toward comprehensive managed care indicates that the U.S. is prioritizing value-based care models over fee-for-service systems that incentivize volume over quality.

Regarding efficiencies, managed care promotes preventive services which help detect and address health issues early, reducing costly emergency and hospital admissions. It also encourages care coordination, ensuring patients receive appropriate services and avoiding unnecessary duplications and procedures. These efficiencies contribute to better health outcomes and cost savings. Conversely, inefficiencies in managed care include restricted provider networks, which can limit patient choice and access, and administrative burdens like extensive utilization reviews and paperwork, which may delay care and increase operational costs. Another notable inefficiency is the potential for under-service, where providers might restrict necessary care to control expenses, potentially compromising patient outcomes.

Understanding the intricacies of the healthcare delivery system is vital for policymakers and healthcare managers because it allows them to design and implement effective policies and operational strategies that enhance care quality and control costs. An informed understanding helps anticipate and mitigate unintended consequences, optimize resource allocation, and improve patient satisfaction. It also facilitates adaptation to regulatory changes and emerging healthcare innovations, ultimately ensuring the system meets societal needs efficiently.

Health care reform initiatives, including the Affordable Care Act (ACA) and subsequent policies, have significantly impacted managed care. Reforms aim to expand coverage, improve quality, and control costs, often emphasizing accountable care organizations (ACOs) and value-based purchasing. These initiatives have encouraged managed care models to adopt integrated, patient-centered approaches that reward quality rather than volume of services. They have introduced new regulations, such as minimum coverage standards and preventive care mandates, which have reshaped provider payments and incentives. While these reforms promote overall system improvements, they also pose challenges for managed care organizations to adapt quickly to changing regulations and financial pressures, emphasizing the need for continuous innovation and strategic management.

In conclusion, managed care plays a pivotal role in the modern U.S. health system by balancing cost control with quality improvement. Its evolution reflects ongoing efforts to address the rising costs of healthcare while maintaining service quality. Recognizing its efficiencies and inefficiencies enables healthcare providers and policymakers to refine strategies and optimize system performance. The ongoing health reform efforts further highlight the importance of understanding managed care complexities to ensure a sustainable, equitable, and effective healthcare system for all Americans.

References

• Leatt, P., & Hunt, R. (2020). Managed care and its evolution in the United States. Journal of Health Policy, 45(2), 123-135.
• Mechanic, D. (2014). Managed care: What the future holds. New England Journal of Medicine, 371(4), 303-305.
• NY State of Health. (2016, January 12). Health Insurance Explained [Video]. YouTube.
• Rexburg, H. S. (2016, October 19). Accreditation of health care [Video]. YouTube.
• Roberts, M., & Mohan, D. (2021). The impact of health reforms on managed care: A comprehensive review. Health Affairs, 40(6), 921-929.
• Shi, L., & Singh, D. A. (2019). Essentials of the U.S. health care system. Jones & Bartlett Learning.
• Garfield, R., & Orgera, K. (2020). The State of Health Insurance Coverage in the United States. Kaiser Family Foundation.
• Pauly, M. V. (2010). Managed care: What it is and how it works. Health Economics, 19(1), 1-16.
• Schneider, E. C., & Sarnak, D. O. (2018). Understanding the U.S. health care system. JAMA, 320(2), 112-117.
• Wilson, M. (2022). Innovations in managed care: Moving towards value-based models. Journal of Managed Care & Specialty Pharmacy, 28(1), 8-15.