Medicaid Managed Care Case Study

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.

The primary reason why the managed care model was created to provide satisfactory and best healthcare to all the enrollees at reduced and controlled cost and its aims to ensure that the healthcare provide a suitable medical condition of the patient and safeguarding such services are provided by appropriate provider. Its emphasis on keeping enrollees healthy to reduce use of services. The two types of Managed Care is Preferred Provider Organization (PPO) the other one is Point of Service (POS) plans. The difference with the PPO is that this is not a restricted as the HMO plan and allows people to approach providers outside of the network.

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

When looking into managed care plans there are several types to choose from. These plans include health maintenance organizations (HMOs), preferred provider organizations (PPOs), point of service (POS), and hybrid varieties. Each type of plan has its own unique characteristics, but ultimately each plan is designed to establish an easier way to access health care. Managed care plans were developed to create a more affordable and effective way for citizens to obtain health insurance. Managed care plans help groups and/or individuals choose a health care plan that is best for them and their families.

Case Project: CVS Pharmacies Plaintiff: United States Health & Human Services (HHS)/ Office for Civil Rights (OCR) Defendant: CVS Pharmacy, Inc. Date of Case: January 16, 2009 Location: United States The media alleged that in several occasions between July 2006 and May 2007 CVS Pharmacy chains all over the United States were disposing protected health information in unsecured dumpsters that were easily accessible by anyone willing to dig in the garbage. The OCR and the FTC (Federal Trade Commission) conducted their investigations of CVS Pharmacy’s compliance with the Privacy Rule. The HIPAA Privacy Rule guards a person’s medical records and other health information by requiring precautions to protect them.

Medicare Supplement Insurance, also known as Medigap insurance is a type of insurance policy that is usually sold by private insurance firms. This type of policy can help you settle some of your health care expenses that the original Medicare policy doesn’t cover. Some of these expenses include deductibles, coinsurance and copayments. Other services that Medicare insurance might offer include medical care when you travel outside the States.

Savannah- “The main quality of an HMO is that a patient must first see a primary care physician and be referred before they can see a specialist.” It is highly important to encourage/recommend people to visit a primary care provider before going to a specialist. It could potentially save a patient time and money. Of course not everyone have the fund to receive care from a doctor office.

The literature support for this project consists of analysis of several studies that examine the impact on access to care for those who live with a minimum of one health condition, and have limited income. Further, the studies examine these impacts on both those less than 65 years-old, and those 65 years-old and greater. Last, the impact of access to transportation is examined with regard to its impact on access to care (access). These issues are contrasted with how telemedicine can improve access for this patient population.

Chapter 10 starts off in identifying the complexity involved in carrying out a general health reform in the United States. It discusses the multiple failed attempts at national health reform over the last century. The factors which our textbook lists as barriers to social reform include “the country’s culture, the nature of U.S. political institutions, the power of interest groups, and path dependency” (Teitelbaum & Wilensky, 2017, p. 170). It then evaluates how health reform was enacted in 2010.

The purpose of this paper is to holistically analyze ObamaCare, also known as the Patient Protection and Affordable HealthCare Act, taking into account both the benefits and shortcomings of this health care plan introduced by the Obama Administration. The Affordable HealthCare Act is not necessarily a newly introduced law, but a law that reforms existing healthcare programs in the United States. The law does introduce new benefits, however, it is largely comprised of new provisions including the mandate for all Americans to have health insurance, the expansion of existing social healthcare programs, and the mandate for large employers to provide coverage to all eligible employees. The goal of the Patient Protection and Affordable HealthCare