Managed Care Policy Analysis

Managers should identify these patients and plan a follow-up treatment plan for them. Fourth, information transparency has become more important than before, and those who pay for the medical services want to know about the medical cost and the quality of care. Also

Hospital readmission is used for several purposes, such as cost control or a correcting measure for length of hospital stay or other outcome. In recent years, there is a great interest in the readmission rate as a representative of quality of hospital care. So, hospital readmission can be viewed as a criteria of poor quality care and have been estimated to cost Medicare that avoidable to spending (1). Despite its use by administering for both quality of health care and cost control, however, the validity of readmission rates as a criteria of quality of hospital care is not evident (17).

I was shocked when the Cleveland Clinic Foundation announced that they were no longer accepting Caresource insurance which is part of the Medicaid program. I knew that this was going to affect a lot of people who count on Cleveland Clinic Foundation for their care. Also, our advancements in technology have been astonishing but still present as a concern because of the cost to purchase, operate, and maintain the equipment is a huge investment in which sometimes the federal government provides financial coverage. In summary, these predicted increases in health care costs must be looked at in terms of prevention and/or cure and effective planning for the the future must start

As mentioned in the Business Insider, anything from high blood pressure to cancer and even to acne, is considered a pre-existing condition. Others include diabetes, asthma and pregnancy. Opponents believe that “the vast majority of Americans with health insurance were already in plans that were required to offer them coverage regardless of pre-existing conditions”, as stated in Forbes. One cannot deny that before Obamacare, perhaps a small percentage of Americans were unable to get coverage due to pre-existing conditions. But, there are ways to see that this could have aggravated if it were not for Obamacare.

In the film Escape Fire the Fight to Rescue American Healthcare, there were many insightful examples of why our Unites States healthcare revolves around paying more and getting less. The system is designed to treat diseases rather than preventing them and promoting wellness. In our healthcare industry, there are many different contributors that provide and make up our system. These intermediaries include suppliers, manufacturers, consumers, patients, providers, policy and regulations. All these members have a key role in the functionality of the health care industry; however, each role has its positives and negatives.

Panning (2014) offers an overview of how the new legislation and its goals are both effective and flawed. Goals of the ACA include: universality, financing, cost reduction, quality improvement, and prevention and wellness (Panning, 2014). Within the context of the ACA is the expectation that the majority of Americans will be covered by health insurance.

In the research conducted by Cox et al., (2012), there were limitations in their sample. Their sample size was too small which makes it difficult to generalize the data and a claim a specific relationship. Further research should incorporate a larger sample size to be considered representative of people to whom results will be generalized and also to ensure a representative distribution of the population. Ineffective screening for comorbid disorders was another limitation in Cox et al. , (2012) research.

The Effects of PPACA on the United States Over 44 million people in the United States currently do not have health insurance. With the Supreme Court’s ruling on the Patient Protection and Affordable Care Act many Americans can receive health care coverage. The Patient Protection and Affordable Care Act (PPACA) is the 2010 health reform act that could extend coverage to 32 million Americans. The PPACA was enacted to increase the quality and affordability of health insurance, uninsured rate lower by expanding public and private insurance coverage, and reduce the costs of healthcare for individuals and the government. (Wikipedia)

Originally, some diseases wiped out thousands upon thousands but today society has eliminated those threats. For a growing society, technology in medicine is necessary to fulfill its demands and to create a better future for mankind. Just this year at the State of the Union, Obama announced that Biden, the Vice President, is taking over the research for a cure to cancer and it would receive complete funding. Therefore organizations and research labs dedicated to finding a cure for cancer will have unlimited funding for whatever they require. Additionally, technology allows doctors easier access to databases to correctly diagnose a patient and find previous records.

First, the ACA has brought about considerable improvements in access to affordable health insurance in the United States. On the basis of their own reports, newly insured Americans are also able to see physicians within reasonable periods of time, and anecdotal reports about restricted access to out-of-network providers, although a concern, have not yet caused a major backlash. Second, the implementation of the ACA has coincided with another important development — a slowdown in the rate of increase in national health care spending. From 2010 through 2013, per capita U.S. health care expenditures increased at the historically low rate of 3.2% annually, as compared with 5.6% annually over the previous 10 years. As a percentage of the gross domestic product, health spending has stabilized at approximately 17%.

This key element restricted health insurance companies in increasing premiums and an opportunity to renewal. The cons with this element is the increase of health insurance premiums across the board. Healthy people are paying the same premiums of someone

The affordable care act, also known as Obama care has been working in America. The plan is far from perfect and will not cover every American who is need of care, but it made a dramatic impact on the state of health care in America. It has made the system better because it has put more money into doctors and hospitals and it has also allowed more people to get covered by health insurance plans. The quality of care his seen an increase in the quality of care, according to the publishers of The Affordable Care act is Working (2015) state that since 2011 there has been an improvement in patient safety and the number of hospital readmissions for avoidable cases has been reduced. This is related to fact that more people are covered; since the act can have

Studies show that manage care that have a higher level of control on patient care it leads to lower medical cost and hospital inflation on cost(Bundorf, Schulman, Stafford, Gaskin, Jollis & Escare, 2004). Also, manage care controls the fees that are paid to physician and manage medical equipment that is provided to the patients (Bundorf, Schulman, Stafford, Gaskin, Jollis & Escare, 2004). The studies show that it is a spillover for manage care and it affects the no managed care patients (Bundorf, Schulman, Stafford, Gaskin, Jollis & Escare, 2004). Most doctors feel that manage care is a positive step for controlling the cost for healthcare. They also, feel that it have a negative impact on medical care (Deom, Agoritsas, Bovier & Perneger, 2010).

Changing the Health care system is hard to do due to the fact that it is very slow to change. Burns, Bradley, and Weiner (2012) states that there are a few issues that make it hard for them to change. The first one is the ferderal government, the government is the biggest payer by reimbursing health care through set prices. Second is consumerism, which can be found as consumer direscted health plans (CDHPs) and health savings accounts (HSAs), medicine offered by physicians to avoid organizations like managed care, person health records, healthcare financial services, and employer wellness programs (Burns, Bradley, and Weiner, 2012). Third, the health care delivery which is controlled by the medical profession that controls up to 85 percent of spending.

Managed Health Care is described as a multitude of various systems and arrangements that are utilized for managing, delivering and evaluating care (Morton, 2014). People enroll in a managed care system as an effective means to receive appropriate medical services within the parameters of their selected plan (Morton, 2014). Managed care, develops services around the patients’ needs in order to reduce duplication and costs all while providing appropriate levels of service in a timely manner (Morton, 2014). Managed care works by, health care professionals and service managers managing care within established constructed restraints all while delivering timely and appropriate health care services. When compared to standard medical insurance managed