Managed care

Therefore, the purpose of this paper is to discuss the nature and types of theory, compare and contrast at least three views of what constitutes a theory, the relationship between theory and research, and to discuss a theory directly related to quality of care in nursing homes. Literature Review The study conducted by Anetzberger (2012) analyzed a variety of studies pertaining to elder abuse since 2000. In addition, the author suggested how the findings of these studies impacted the…

Affordable Care Act (ACA) there have been many recommendations to improve the health care of all Americans. These recommendations are designed to expand coverage, hold insurance firms accountable, decrease the cost of health care, offer more choices, and enrich quality of care. While these recommendations are aimed at patients, nurses will inevitably be affected in the way they give care. The ACA has proposed three models of care that are designed to reduce costs and provide a value-based health…

The project focuses on an analysis of the TRICARE medical care network, which is the cornerstone of the United States Department of Defense Health Care system. TRICARE has undergone transformation through the years, and within a challenging health care environment.is presently undergoing a wide-range of controversy, or scrutiny from a myriad of opponents and proponents. Observations and research consisted of reviewing the progression of the health system from its original inception to its…

insurance because they would rather pay a small premium than have the risk of getting sick and having to pay large medical bills. Consumers may purchase additional health care services only because they have insurance so insurance companies implemented co payments and managed care. The implementation of co pays and managed care was designed to keep the consumer from receiving additional services that may not be necessary or are of low value. Most people purchase insurance to have a safety net…

Beneficiaries choose a primary care physician (PCP) and for any specialty care outside the scope of their PCP secure referrals and authorizations (DHA 1). The offset for such limitations is a small copayments for each visit (retirees and their families only). There is an annual enrollment fee for Tricare Prime for military retirees and their family members. There is no enrollment fee for active duty military and their family members. Next is Prime Remote, a managed care option available in…

The Patient Protection and Affordable Care Act is one of the Barack Obama's domestic policy that has been debated about by the public on its viability since the president signed it. The Act also is known as the Affordable Care Act, or the Obamacare and was passed by the 111th Congress of the United States. The Act was signed to become one of the U.S. federal statutes on March 2010, and it was meant to change and help in the development of the healthcare system in the country (eHealth, 2016). The…

individuals over 65 years of age depended on others for activities of daily living, and often in institutional care. For this reason, an effective patient care and management depends on the team. To balance the need for representation with the need to keep the task force size manageable, first, I will make sure I hired competent trained individuals who are already trained in providing efficient quality care. I will work with a team that is interdependent in their tasks. For example, I will work…

Health Prevention Initiatives Managed care focuses heavily on health prevention initiatives as a critical component to decrease overall health care costs, as preventing disease has a direct cause and effect relationship with healthier populations, which result in lower overall health care costs. The Centers for Medicare & Medicaid Services (CMS) defines preventative care as health care that includes “immunizations, screenings for common chronic and infectious diseases and cancers, clinical and…

population must address health care disparities and inherent patient characteristics related to preventable morbidity and premature mortality in this country. The lack of emphasis on the social determinants of health they relate to population health management is a major problem leading to the suboptimal performance of our healthcare system. Research by the Wisconsin Population Health Institute (2015) found that factors outside of traditional boundaries of health care delivery,…

population by identifying and prioritizing the community needs. Although the region had faced many challenges to overcome quality care and healthy life, its efforts resulted in better health outcomes. According to the case study, the four high-performance pathways the Southern Arizona region underwent great progression were community-organizing efforts, use of advanced managed care techniques, collaboration among providers and community groups, and programs to address the needs of underserved…