Managed Care Failure

Improved Essays
CMS (2015) informs us that in 1990's managed care plans managed reducing costs by negotiating discounts from providers and used lower cost settings (i.e., hospital versus ambulatory surgery center). As consumers required less restrictive care their utilization increased and such health expenditures increased. This is not because the managed care organizations (MCO's) have failed or they do not contain costs, it is a function of consumer demand. MCO's work diligently to control costs by ensuring the care is delivered in the safest cost effective setting, managing staff patient ratios, leveraging size to obtain the lowest possible price and standardizing the supply chain.

MCO's can effectively manage costs, especially when compared
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Carmen et al. (2015) reports a 6.9 million enrolled in Medicaid during the period September 2013 and February 2015. With the trend of Medicaid plans using MCO's, the Medicaid Expansion component of the ACA will inevitably grow and take a much larger role in healthcare delivery. The ACA has undeniably expanded coverage but there are questions on whether or not it has provided better access and …show more content…
In the survey, four of the top 5 plans were or has MCO options for care. While the clinical measures earned the top five the highest ranking, it was interesting to note that patient satisfaction was not ranked as high performing. I can't help but wonder if our instant access to information and for some, a need for immediate gratification, impacts the perception of our MCO. The organizational goal is to manage quality and cost, for our benefit. This will inevitably result in denials and waiting for clinical trials to prove benefit. Yet, we are inundated with information, not all of it complete and accurate. Many use this information to self diagnosis and treat. Some walk into their provider office with a treatment plan in mind. When denied access to this plan, do we feel cheated, not cared for or mistreated leaving us with a negative perception of the MCO and its commitment to

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