Managed care models are strategies put in place to safeguard the functions and activities of the managed care facilities within a country. The managed care models usually have a continuum to guide their activities and operations. The continuum, therefore, is critical to understanding the differences between managed care plans. In particular, the continuum is responsible for the scope of control a managed plan has over the activities of health facility (Martino, Elliott, Haviland, Saliba, Burkhart, & Kanouse, 2016). As a result, it helps in clarifying the main reason behind the differences in the control of the managed care models.
In addition, managed care organizations are rampant in some places or rather regions in the world. The kinds of MCOs that will be most common in an area depend on the perception of the health providers towards the management of such organizations. For instance, in my area, the MCO is a special type of managed care organization called the BCBS is present. This organization is special because it manages not only the quality of services provided but by extension; it offers free services to the health facilities (Martino et al., 2016). The free services mostly cover the education to practicing nurses and doctors in the health sector. Furthermore, this type of MCO is present in various other parts of the country especially in various big cities like for example the New York City.
Comparison of the Organizations
The BCBS present in my area and that found in the New York City provide health products that are in a way different to each other. The products offered by the organization in my area are regulating and controlling the prices and charges of health services from the providers. While that from the New York mainly offers, services to control the quality of services provided. In contrast, the organizations attach different qualities and importance to varying levels of control to the managed care models.
Comparison of the Findings with the Class Readings
The findings indicated that most of the managed care models available at any given time are the quality of service provided. However, the class reading expounded that there is the provision of some other products including control over the maximum charges payable to acquire health services from the health facilities (Blais, 2015). The class readings, therefore, differ with actual findings because the provision of the health products usually does not appear as stated in the readings.
There are some health products available for the managed care models; the employees can have access to the following products HMO, PPO, or CDHP. The best product recommendable for my employees is the HMO because it offers the financial assistance to the patients.
A physician’s contract has some key elements that are very crucial for the implementation of the agreement between the physician and the Managed Care Organization. In particular, the key elements in the agreement are the principle of utmost good faith, information disclosure from both parties and a binding agreement on the contract. These three elements are the most important aspect of any given contract especially for the case of the physician’s contract.
Furthermore, the provisions and clauses of the physician’s contract range from a wider spectrum to a more specific clause that governs the operations of the contract. One of the most common clauses is the clause that states that in the case of termination of the contract from either party, a warning should be in writing. Secondly, a clause on compensation provides clarification on the procedures followed by the physicians in the case of losses (Blais, 2015). On the other hand, the provisions available give an allowance on instances where the activities occurring within the limits of the contract provided solutions outside the scope of the agreement.
Finally, the process of negotiating for the contract is a somehow complicated activity since there is a particular procedure to follow. The physician needs to take the first step through writing an application form for the contract to the MCO and provide all relevant documents. Consequently, the MCO will then reply and specify the charges payable for the initiated contract.
References
Blais, K. (2015). Professional nursing practice: Concepts and perspectives. Pearson.
Martino, S. C., Elliott, M. N., Haviland, A. M., Saliba, D., Burkhart, Q., & Kanouse, D. E. (2016). Comparing the Health Care Experiences of Medicare Beneficiaries with and without Depressive Symptoms in Medicare Managed Care versus Fee‐for‐Service. Health Services Research, 51(3), 1002-1020.
