How have Managed Care Plan Models Changed over the Last 5 Years – Health System Example

Download free paperFile format: .doc, available for editing

"How have Managed Care Plan Models Changed over the Last 5 Years" is a decent example of a paper on the health system. Managed care plan models have significantly changed over the last five years due to the increase in health care requirements and the need to provide quality medical attention to everyone. Managed-care plans, which refers to health insurance plans that will ensure that health services are provided to members at low costs and at high quality. Managed-care plans will ensure the provision of health care services, whereby an appointed organization is responsible for managing finances, insurance, delivery, and payment of these services (Shi & Singh, 2010).

Its main purpose is to control the quality of health care delivered and the amount of reimbursement to providers. Managed care plan models are the different forms in which managed care exists. These include Health Maintenance Organizations (HMO), Point of Service Plan (POS), and Preferred Provider Organization (PPO). These models are gradually evolving over the years and have seen significant changes over the past five years. These changes include alterations of features of the managed care models.

It has been noted that features from one type of model are being incorporated in other models as well as the addition of new features altogether. For instance POS is a hybrid of HMO and PPO, combining advantages of both overcoming restrictions of provider choice and tight utilization management. Enrollment to managed care plans has increased and hence growth and expansion into rural markets. They have enormous bargaining powers and have increased their membership due to the numerous benefits. The increase of power for the MCO has pressurized independent health delivery organizations such as clinics and hospitals to integrate into networks for survival.

Managed-care plans have always competed with commercial insurers but now are products within the insured business line.   The quality of healthcare has improved. There are fewer differences in health care access and utilization with regard to income and race. Most of these models enter into contracts with a broad panel of physicians and give the enrollees the opportunity of seeking care outside the networks. There is heavy competition between the various managed care plans and this has resulted in each plan increasing the benefits given to members.

There is a shift to a more patient-oriented approach in providing care in that there are numerous options for the enrollees, with access to primary care, preventive and health promotion services (Shi & Singh, 2010). To an extent, these models have ensured that enrollees assume more responsibility for their care due to outpatient services. The causes of these changes can be attributed to changes in insurance premiums that are on the decline consistently. This is because of higher cost-sharing hence shifting costs to the insured.

The growth of MCO is also a result of organization integration that helped minimize financial uncertainties as well as expansion to new markets. Another reason for the change is the shift of focus to the enrollees where they are able to choose the right plan for themselves. There is a demand for quality and increased assessment and planning for the continuum of care. The government has also played a major role especially in influencing cost containment through control of Medicaid and Medicare cost, which ensure that people are able to access medical attention at low costs.

References

Shi, L. & Singh, A .D. (2010). Essentials of the U.S. Health Care System 2nd Edition. Boston. Jones & Bartlett Publishers
Download free paperFile format: .doc, available for editing
Contact Us