Pcmh Model Of Managed Care

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

In a major managed care organization, health care can be improved through the adoption of the Patient Centered Medical Home model (PCMH). In this model the main concept is patient focused. This model improves care by creating individualized care plans based on patient need (Morton, 2014). Thus, a partnership is developed between the healthcare system, providers, care teams, patients and their families (Morton, 2014). This partnership fosters a sense of ownership which creates a collective responsibility of all parties involved (Morton, 2014). Thus, the PCMH model has been proven to improve overall experience of care, enhances quality of care, safety, efficiency, and adds an intrinsic value to patients (Morton, 2014). Using the PCMH model, some medical providers or health care teammates may not appreciate patient contributions. The implementation of this model may have some growing pains but should be alleviated with a centralized and robust training program. Furthermore, in this model patient satisfaction scores are highly regarded. Thus, it is critical for management not to overreact to poor reviews until all facts are

Now days, individuals are quite busy with the daily routines of life and often a physician office visit may be seen as an inconvenience. Furthermore, a managed care organization should evaluate the amount of afterhours care and network leakage. It is a possibility to offer staggered physician schedules in order decrease barriers to care and improve availability. After hours care can help maintain a link to the primary care provider, provide consistency in care, reduce unnecessary emergency room visits and increase the overall quality and perceived value of care. As with any schedule change there will be growing pains. The organization may look into asking for volunteers to fill off normal hour care and possibly offer financial incentives. This type of plan needs to carefully be considered and will require the analysis of current data and trends in order to determine the size and scope of organizational needs. Managed care has evolved into the current primary choice of health care in the United States. Granted, even a poplar health delivery system such as managed care is not without its faults. Hence, every organization should constantly strive to improve themselves. Thus, a managed health care plan may be improved by adopting the PCHM model, utilizing health care extenders, and improving access to care to include afterhours