Managed care in US

Outline

Introduction

The managed care plans the budget for the members, whether they are ill or not. The managed care has the description of a continuum of the arrangements that are the integration of delivery of healthcare and financing.

Background

Managed care has been a highly common means of providing healthcare services to the people in United States. Whereas, there are most of the time values in consolidation of services and products under an organizational structure, there can be several issues, when the bureaucrats are against the organizational structures.

The Challenges and Problems Associated With Managed Care

The regulations, support and interventions of government in United States have been increasingly affecting the operations of payers, cost and the strategies of marketplace.

Legislative reforms whether piece meal or detailed and whether state level of at federal level have been leading to a large number of new grant programs and agencies in addition to the adjustment to payment and market of insurance in medical care.

The affect of variation in ICD-10 for the billing and coding of medical record has been underestimated in United States..

Real time support of decisions, disease management and protocol development together with customer segmentation has been constantly driving investments in analytic.

The executions of HIPAA 5010 have been requiring new changes to the systems of software and the procedures

Consumers have been raising their voices against the products and services offerings, reform cost, and networking.

Automated Retention and Member Acquisition together with Transparency in Operations and Health Plan Data are major challenges as well.

Literature Review

The Pros

When the healthcare services have consolidation in an organization, there is a great deal of opportunities for efficiency and streamlining. Managed care institutes are able to standardize their philosophies of healthcare, improved communication between purchasers and doctors. Furthermore, they can create the solutions based on technology that are helpful for the aspects of data care of patients. Furthermore, managed care facilities provide people the opportunity to observe a collection of various specialists instead of the patient searching for individual healthcare professional in a large number of places

The Cons

The managed care can be complex for some people for navigation of managed care institutes. People can go through difficulty to deal with the intricate paperwork, treatment approvals and delays in healthcare process.

Recommend Solutions

Interventions for Higher Quality and Low Cost

Integration of Reforms of Delivery Systems

Reforms for Transition Providers Reimbursements

Implementation of Changes Together

Conclusion

It is significant for the managed care to develop the integrated delivery system in order to target the patients with multiple chronic illness and low income strata.

Managed care in US

Introduction

The managed care plans the budget for the members, whether they are ill or not. The managed care has the description of a continuum of the arrangements that are the integration of delivery of healthcare and financing. Practically, managed care has encompassed broad range of arrangements; some of the arrangements are the resemblance of discounted fee for service and others with the use of gatekeepers and capitations. These capitations are the primary care healthcare professionals who provide healthcare services to ...