Essay \"Managed care trends in america\" - grade A PDF

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Managed Care Trends in America...

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Running head: MANAGED CARE

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Managed Care Issues/Trends Ashford University MHA690: Health Care Capstone February 17, 2014

MANAGED CARE

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In this paper, three of the most significant issues/trends in managed care today will be discussed. The explanation as to why these three trends/issues are the most significant is because U.S. health care costs have been on the rise. The government has recently been making attempts to work with the managed care industry to improve quality of care, induce efficiency, and create cost-savings. The first trend is the move from managed care to accountable care. The second trend is the increasing enrollment in consumer-driven health plans. The third issue is health reform. These three issues/trends will largely be affecting the managed care industry today and for years to come. Accountable Care Organizations One trend in relation to managed care is the replacement of managed care with accountable care. With the enforcement of the Affordable Care Act in the United States, more healthcare organizations will be transforming into accountable care organizations. Accountable care differs from managed care in that patients will be able to have more choices regarding where they seek care and how. With the accountable care organizations, patients will be allowed to choose health care providers that are not within a certain network. Health care providers will be encouraged to work as a team, coordinating care and centering care around the patients' needs and preferences (Hammack, 2013). Accountable care organizations will be challenged to reduce healthcare costs while also increasing the quality of care provided to patients. The providers will receive incentives if they bring about savings to the Medicare program. The incentive will come from the savings that they bring. Health care providers will be encouraged to improve quality of care, especially for

MANAGED CARE populations that are at-risk (Hammack, 2013). As the managed care system changes, becoming more like accountable care, it is important for consumers to know and understand what changes are being made and how they will be affected. Consumer-Driven Health Plans Recently, there has been a rise in enrollments in consumer-driven health plans. Consumer-driven health plans are health insurance plans that tend to include a health savings account. Enrollees pay for health services using the money from these health savings accounts. Once there is no more money available in the health savings account, then the enrollee begins to pay for the health care services out-of-pocket. This is until they have met the deductible limit. Once the deductible limit is met, the enrollee begins to have coinsurance-based coverage. The health savings account can be funded by both an employer and the employee (Park, 2012, p.1). Consumer-driven health plans are different from regular managed care plans because consumers have more responsibility in relation to health care spending and decision-making. The enrollees are to remain informed about their choices, and tend to choose lower cost options for their health care services and products. They demand information transparency from providers and pharmacies, and are more likely to discontinue unnecessary or poor quality care. There are many states, both Republican and Democrat, that are choosing to adopt consumerdriven health plan strategies into their Medicaid policies, because it has been shown that these plans help to improve cost savings and also improve consumer engagement (Park, 2012, p.4).

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Healthcare Reform Managed care organizations will be greatly affected as consumers will be migrating towards government coverage and stepping away from private health insurance. Employers with 50 or more employees will be mandated to offer employees health plans that are approved by the government or they will be subjected to a fine by January of 2014. Everyone in the U.S. will be required to enroll in health plan exchanges, run by either the federal or the state, or enroll in Medicaid. Proof of coverage must be shown on income tax returns (Sonderling, 2013, p. 1). Managed care companies will feel the pressure to show that their plans aligned with government requirements, improving quality of care to patients, and reducing health care costs. There will be Medicaid expansions in most states. Providers will no longer be paid fee-forservice. They will be paid based on their performance in certain quality measurement areas set by the government (Sonderling, 2013, p. 2). One major change that has been emphasized on since the introduction to health reform in recent years, is the fact that during the underwriting process for managed care companies to provide coverage to applicants, applicants cannot be denied coverage because of pre-existing conditions. Healthcare reform will significantly affect consumers, employers, the managed care industry, and the health care industry as a whole. In conclusion, three of the most significant issues/trends in managed care today were discussed in this paper. The explanation as to why these three trends/issues are the most significant is because U.S. health care costs have been on the rise. The government has recently been making attempts to work with the managed care industry to improve quality of care, induce efficiency, and create cost-savings. The first trend is the move from managed care to accountable care.

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The second trend is the increasing enrollment in consumer-driven health plans. The third issue is health reform. The migration from managed care to accountable care is significant because the way that health care will be administered to patients will be completely altered. Providers and patients will be encouraged to work as a team in order to improve quality of care. Consumer-driven health plans have become in increasing trend in managed care because of their studied results in consumer engagement and cost-savings. Consumers demand transparency from providers, choose lower cost health services and products, and are likely to forego unnecessary or poor quality care. Health reform will probably the most significant issue that will affect the managed care industry. It will transform the entire process of how consumers are treated and how providers' performance will be measured. These three issues/trends will largely be affecting the managed care industry today and for years to come.

MANAGED CARE

6 References

Hammack, L. (2013). Carilion to participate in national health care program. McClatchy -Tribune Business News. Retrieved from ProQuest database Park, T. (2012). What we can expect from consumer-driven health care. Innovations in Pharmacy, 3(1). Retrieved from http://www.pharmacy.umn.edu/innovations/prod/groups/cop/@pub/@cop/@innov/documents/art icle/cop_article_381374.pdf Sonderling, H. (2013). Managed care facing a new world in 2013 and beyond. Retrieved from https://www.columbiamanagement.com/content/columbia/pdf/HEALTHCARE_EXTRACT.PDF...