Introduction
The term managed care refers to various healthcare insurance plans used in the United States, which are aimed at moderating the cost of providing care to the citizens. Essentially, the techniques used are intended to enhance the quality of patient care provided in the medical facilities. The approaches also include the systems of financing the enrolled organizations under the managed healthcare concept and techniques. In this essay, three types of managed care plans will be discussed. Furthermore, their impact on the way services are delivered at Healing Hands Hospital will be included. The paper will identify the changes that managed care has experienced over the last ten years and discuss the future for the approach as a viable reimbursement model for Healing Hands Hospital. Lastly, the paper will describe the impact of the Affordable Care Act and MACRA as regulations that influence reimbursement and patient care in Healing Hands Hospital. Managed Care model is a better compensation model compared to Accountable Care Organization and Value Based approaches.
Types of Managed Care Plans
Preferred Provider Organizations
The PPO plan is designed as an arrangement with a particular system of hospitals, doctors, and other healthcare providers that have contracted to accept low fees from their insurance providers. In that case, one’s cost sharing is usually lower compared to costs outside the network. The PPO arrangement allows the physicians to make referrals to members and individuals outside the plan (United Health Care, 2017). The Preferred Provider Organization approach influences health care delivery in Healing Hands Hospital as the provision to seek direct treatment from the doctors helps in building patient volumes.
Health Maintenance Organizations
The model allows the members to receive various health benefits as long as they seek care from the facilities and institutions under the HMO network. The approach attracts monthly premiums and provides the carriers with preventive health care services such as hearing tests, annual check-ups, and flu shots (United Health Care, 2017). HMO impacts patient care delivery at Healing Hospital as only resisted members are allowed to visit doctors in the institution.
Point of Service Plans
In this structure, the patients are allowed to obtain health care services outside the network. However, the individuals are required to cover large sums of deductibles (United Health Care, 2017). The approach affects health care delivery, and the volumes of people seeking medical attention in Healing Hands Hospital as patients have the freedom to choose to receive services from physicians outside the facility.
Changes in Managed Care
In essence, managed care has changed significantly over the last ten years. More so, the program has experienced modifications in health care spending, policy, and legislation. A decade ago, the national health expenditures were reviewed depending on the aggregate economic trends (Martin, Hartman, Washington, Catlin, & National Health Expenditure Accounts Team, 2016). Today, the managed care model has developed to ensure that the changing economic trends do not affect how the health care providers and insurers provide the services to the citizens. Also, development of legislation and policy has enabled the patients to have the liberty to seek care from providers that are outside the managed care network.
The Future of Managed Care
A significant number of states have had a renewed interest in implementing the managed care approach in their medical facilities. As a reimbursement model for Healing Hands Hospital, managed care promises more expansion of medical programs and more so, an increase in patient volumes. Accountable Care Organizations is a structure that includes a network of hospitals, doctors and other providers that work collaboratively to provide harmonized care to the Medicare patients (McClellan, McKethan, Lewis, Roski & Fisher, 2010). The Value Based model emphasizes on paying the providers for the value of services. As a reimbursement plan, Accountable Care Organization and Value Based Approaches require that the care providers account for the services they provide to a given population. In this case, the structure denies the organizations the liberty to give care to a significant number of patients as they are paid based on value and accountability. For this reason, the managed care program is the favorable reimbursement program for Healing Hands Hospital.
Accountable Care Organizations Models
Independent Physician Group
The approach includes a single institution that directly provides outpatient medical care.
Physician Group Alliance
The structure involves multiple organizations, which directly give outpatient care.
Expanded Physician Group
The model requires that an institution provides outpatient care, and is allowed to contract for the inpatient services (McClellan et al., 2010).
Independent Hospital
The model required that a single organization provides inpatient care.
Hospital Alliance
In this structure, multiple groups come together, with one providing direct inpatient care (McClellan et al., 2010).
Impact of Affordable Care Act and MACRA
Affordable Care Act is legislation that seeks to insure all the Americans by expanding Medicaid coverage in the state. On the other hand, the MACRA- Medicare Access and CHIP Reauthorization Act is a regulation that establishes the guidelines for paying the physicians that care for the Medicare beneficiaries (Hall & Lord, 2014). Given that MACRA and Affordable Care Act include guidelines for funding providers and providing technical assistance, Healing Hands Hospital can expand their financial plans and create new programs that would improve the quality of care.
Conclusion
Managed Care model is a better reimbursement model compared to Accountable Care Organization and Value Based approaches. In fact, through the three managed care structures, Healing Hands Hospital can increase the number of patient volumes and maintain high-quality services. Research revealed that managed care structure is a better reimbursement approach compared to the Accountable Care Organizations and Value Based models because Healing Hand Hospital will only receive pay based on the value they provide if the latter schemes were used. Essentially, the Affordable Care Act and the MACRA are regulations that affect service provision and reimbursement. However, the financial assistant provided to the enrolled institutions allows them to expand their programs and thus enhance the quality of care given to the patients.
References
Hall, M. A., & Lord, R. (2014). Obamacare: What the Affordable Care Act means for patients and physicians. Bmj, 349(7), g5376-g5376.
Martin, A. B., Hartman, M., Washington, B., Catlin, A., & National Health Expenditure Accounts Team. (2016). National health spending: Faster growth in 2015 as coverage expands and utilization increases. Health Affairs, 1077-1377.
McClellan, M., McKethan, A. N., Lewis, J. L., Roski, J., & Fisher, E. S. (2010). A national strategy to put Accountable Care into practice. Health Affairs, 29(5), 982-990.
United Health Care. (2017). Managed Care. UHCSR. Retrieved from https://www.uhcsr.com/SelfServiceSupport/Students/HealthInsurance101/DetailsManagedCare.aspx.
