Managed Care Research Paper

You are a new physician setting up your practice in a new town. You are researching the different MCOs offered in your area and are considering becoming a physician for one of these networks. You have also invited the sales representatives of several healthy plans to speak with you about the benefits of choosing their plans.

How managed care plans contribute to public health practice. This article looks at alliance between Health plans and public health agencies. They discuss how public health care plans have similar needs also may have similar needs for the expertise and clinical capacity to serve vulnerable and underserved populations. Health care plans that are in place now to assist people with having access to health care.

Under direct contracting, providers must go beyond their traditional roles as suppliers of care to owners of integrated financing and delivery systems. This transition can be difficult for employers to compile and manage actuarial and legal mandates. A physician group can be presented as a threat to health plans, as it does business by obtaining an insurance license. This is because the subcontractor is a competitor. Providers must become active managed care partners with employers, instead of being reactive adversaries of managed care organizations on a contractual basis.

The Health Insurance Portability and Accountability Act, or HIPAA, was passed by the U.S. Congress and signed by President Bill Clinton in the year 1996. As a broad Congressional attempt at healthcare reform HIPAA was first introduced into Congress as the Kennedy-Kassebaum Bill named after two of its leading sponsors. The law has several different purposes that mainly focus on the protection of the healthcare provider and their patient depending on the circumstances and situations that may typically occur in a medical environment. The act itself was passed with two main objectives.

(FOR EXAMPLE): You have a situation you awaken in the morning and see some type of brownish spots on your arm, as an HMO policy holder you cannot go straight to the dermatologist. The person would have to see your primary doctor first, before it can be determined, if it is necessary to see a specialist or not. Moving on to (PPO) this is one policy that I would like to be

The goals of HIPAA are to ensure medical coverage scope for workers and their families when they change or lose their employments and to secure wellbeing information trustworthiness, classification, and accessibility. The objectives are also to enhance our health care framework by making it more proficient, less difficult, and less

HIPAA is the federal Health Insurance Portability and Accountability Act of 1996.

“Healthcare Reform 101,” written by Rick Panning (2014), is a wonderful article that describes, in an easy-to-understand language, the Patient Protection and Affordable Care Act, signed into law March 23, 2010. The main goal of the Patient Protection and Affordable Care Act was to provide affordable, quality healthcare to Americans while simultaneously reducing some of the country’s economic problems. Two areas will be covered throughout this paper. The first section will include a summary of the major points and highlights of Panning’s (2014) article, including an introduction to the ACA, goals of the signed legislation, provided coverage, and downfalls of the current healthcare system. The second part will be comprised of a professional

Prior to the implementation of the Affordable Care Act (ACA), few people anticipated employer-provided health care would disappear as a major player in the United State healthcare arena. However, ACA adoption and has put more than 169 million employees at risk for losing their workplace coverage. Several studies indicate employer-based coverage will decline rapidly over the next decade as the traditional US system is displaced by the healthcare exchange system. While consumers grapple with finding affordable coverage options and providers adjust to the new norms, there is another wrinkle in the mix. In January, Health and Human Services (HHS) Secretary Sylvia M. Burwell announced the agency's push toward value-based and alternative reimbursement models. HHS expects 90% of Medicare payments to be directly tied to quality measures by 2018. It is imperative that hospitals, urgent care clinics and frontline providers align their

Health care includes preventive, diagnostic, therapeutic, rehabilitative, maintenance, or palliative care, and counseling, services, assessment, or procedure with respect to the physical or mental condition, or functional status of an individual. Health Care Clearinghouse, Businesses that process or facilitate the processing of health information received form other businesses. It includes groups such as physician and hospital billing services. Health Plans, Individuals or group plans that provide or pay the cost of medical care and includes both Medicare and Medicaid programs. HIPAA protects an individual’s health information and their demographic information.

Managed Care plans are also known as prepaid health care plans. Managed healthcare plans strive to deliver high-quality healthcare, while controlling cost. Services and fees are negotiated with healthcare providers and facilities to provide access to otherwise expensive healthcare services to patients. Services under listed within the Managed Care plan monitored continuously to ensure that all services are provided in the most cost effective manner. An HMO or Health Maintenance Organization is an example of a Managed Care Plan. In an HMO, a patient pays a monthly premium and only has access to doctors, hospitals, and other healthcare providers that are within the HMO network. To participate in an HMO, the individual must pay a monthly premium,

The Affordable Care Act: Bad For Some, Great For Millions For sometime, many US citizens have not had the resources to acquire an adequate health insurance plan. Although faced by many oppositions, the US government has found a solution, The Affordable Care Act. The Affordable Care Act, also known as “Obamacare”, is a US healthcare reform law that focuses mainly on providing more Americans with access to an affordable health insurance. The Affordable Care Act is said to expand the affordability, quality, and availability of private and public health insurance through consumer protections, regulations, subsidies, taxes, insurance exchanges, and other reforms. Signed into law by President Obama in March 2010, hence the nickname “Obamacare”, the

Some variability differs with the capability of providing out-of-network health providers and the services in which can be provided. By having a broad range of choices that can be provided, will cause a higher the cost for the individual that is paying. Most Medicare patients have received the managed care plans due to promises of a lower copayment amount and often medication benefits. Medicare post-acute spending has grown rapidly with the number of users between 1999 and 2007. The growth in Medicare short-term post-acute service use, in part, reflects short hospital stays and a growing demand for rehabilitation services.

HIPAA Summary In 2009, the Congress created an act called Health Insurance Portability and Accountability Act (HIPAA). It is designed when people became concern about his or her personal information being stolen. With the media growing every day, it has become easier for people to hack into computer take identities and putting others at risk. The federal government made HIPAA way to reduce company’s downfalls and financial crisis due to theft.

It is the classic example of market failure. All in all, government intervention in healthcare is due to the government intervention itself. These interventions include the patent law which deliberated to advocate innovative activity and licensure which is intended to maintain minimal standards of quality. All these contribute to the monopoly power that dominates the whole market as well. The specific person or enterprise manages to control the whole market since they are the only supplier of a particular commodity.