Health Care Reform Part 3

Topics: Preferred provider organization, Health insurance, Health care Pages: 11 (347 words) Published: June 22, 2015
Health Care Reform Part 3
K E L LY J O N E S
HCS/440
JUNE 08,2015
LORI GEDDES

Managed Care
HMO

Health Maintenance Organization pays for care within
the network. The patient gets to pick their provider.
PPO
Preferred Provider Organization, the patient pays
more out of pocket if they receive care within the
network.
POS

Point of Service , this plan lets you pick between HMO
and PPO plans

Growth in Managed Care

The "Executive Summary Improving The Delivery Of Alcohol Treatment And Prevention Services A National Plan For Alcohol Health Services Research" (n.d.) website 

Effective Methods and tools
 Review of medical necessity
Incentives to use certain providers
Case management.

Managed Care

 ("Managed Care", n.d.)

Payment sources and mechanism used
Medicare
Medicaid
Private insurances

Growth of Managed Care
Market driven
Customer desire
Unmet needs

Effective way to resolve issues
Increasing health expenditures
Strained public finances

Conclusion
The worst part of managed care is that

providers can decide the service and access
because the fee of service treatment is
limited to what the providers think is right.
 “All managed care plans have a built-in
incentive to limit costs, because more
treatments do not automatically mean more
revenue for health providers.” (Managed
Care: Get Used To It" (2010).

References
EXECUTIVE SUMMARY IMPROVING THE DELIVERY

OF ALCOHOL TREATMENT AND PREVENTION
SERVICES A NATIONAL PLAN FOR ALCOHOL HEALTH
SERVICES RESEARCH. (n.d.). Retrieved from http://
pubs.niaaa.nih.gov/publications/exsum.htm
Rosenberg, Ira H. (1998). Case Management. Retrieved
from http://www.mcres.com/mcrmm06.htm
Managed Care. (n.d.). Retrieved from http://
medicaid.gov/medicaid-chip-program-information/by-top
ics/delivery-systems/managed-care/managed-care-site.h
tml
Managed Care: Get Used to It. (2010). Retrieved from
http://www.nytimes.com/2010/03/14/business/14views.ht
ml?_r=0

References
Managed Care. (n.d.). Retrieved from

http://wirtschaftslexikon.gabler.de/Definition/
managed-care.html
Managed Care: What Went Wrong? Can It Be
Fixed?. (1999). Retrieved from
http://www.gsb.stanford.edu/insights/manage
d-care-what-went-wrong-can-it-be-fixed
MEDICAL NECESSITY
DEFINITIONS. (2015). Retrieved from
http://www.cigna.com/healthcare-professionals
/resources-for-health-care-professionals/clin
ical-payment-and-reimbursement-policies/medic



References: Fixed?. (1999). Retrieved from
http://www.gsb.stanford.edu/insights/manage
DEFINITIONS. (2015). Retrieved from
http://www.cigna.com/healthcare-professionals
Continue Reading

Please join StudyMode to read the full document

You May Also Find These Documents Helpful

  • Health Care Reform Essay
  • Health Care Reform Project, Part I Essay
  • Essay about Health Care Reform Project Part 2
  • Health Care Reform Part III Essay
  • health and social care level 3 Essay
  • Essay on Changing Landscape of Health Care
  • Health Care Reform Essay
  • Health Care Reform Essay

Become a StudyMode Member

Sign Up - It's Free
Louis Begley - Mistlers Abschied | Quotidien | Privacy Policy