Managed care

Managed Care is a health care delivery system set up to manage cost, quality, and utilization. Medicaid Managed care allows for the delivery of Medicaid health benefits and additional services through contracted arrangements between Medicaid agencies and Managed Care Organizations (MCOs), that accept a set number per member per month (capitation) payment for services. By contracting with various types of MCOs to deliver Medicaid program services to beneficiaries, states can reduce Medicaid…

Should Medicaid and Medicare entitlement programs be run by the government or by private managed care organizations? Why do you think Medicaid managed care has been mandated in many states? Why do you think Medicare managed care has not been mandated? With all the challenges looming around Medicaid and Medicare, have more confidence that a private entity would spearhead the management of funds with stringent…

There are many forces driving Managed Care Organizations (MCO’s) that requires close attention to the quality of care given to patients and the patient outcome results from services provided. MCO’s have evolved from employing the traditional Quality Assurance (QA) mechanisms in evaluating patient care outcomes and have ushered in the era of Quality Management (QM). Healthcare is an ever-changing flux environment that is seeking to provide quality care in a cost effective manner to achieve the…

Nurse-Midwife managed care improves satisfaction Satisfaction has become a metric that helps determine reimbursement by Medicare and insurance companies. This change is due to the Affordable Care Act(ACA), and was done to improve the care provided by hospitals and providers to patients. The ACA has gone into effect since Paul, Jordan, Duty, & Engstrom (2013) released their article on using certified nurse midwives(CNM) to improve patient satisfaction and care. (Paul, J., Jordan, R., Duty, S.,…

different types of Managed Care Plans. People want to carry health insurance to help cover them in case of a health emergency. Firms sell insurance because they are paid a set amount to assume a risk that can be managed by spreading it over a large pool of insurers. Insurance companies set premiums based on the expected payout along with other costs. Typically, health care is provided by a managed care organization (MCO) to a defined population at a fixed monthly rate. Managed care has three…

I am a Registered nurse with 29 years of experience but this is the first time I have worked on the insurance side of the healthcare industry. I am currently employed by a large Managed Care Organization/Insurance company. My division’s job is to provide home and community based services to members in need; to keep them safely and cost effectively in their homes. As I think about what makes our company successful and what core values have an impact on that success, I find myself thinking about…

believe that only plan decision is being chosen by customers. In contrast, in the derived demand management, hospital can make itself very attractive for the managed care organizations, HMO and PPO. Hospital can create the demand to customer choose their service through the plan. Two stage marketing process in derived demand. The first, managed care organization should create little long-term discount option based on their true capacity to serve. Consumers have to keep the chosen plan as long as…

Health Care Plans Define, compare and contrast fee-for-service and managed health care plans. What are the similarities and differences? Support your response with one citation and specific examples. Fee-for-Service Plans This type of health insurance program provides protection against health care expenses in the form of a cash benefit paid to the insured or directly to the health care provider after the employee has received health care services (Martocchio, 2014, p. 145). This means that…

During this rating period, Zhenya Gezalyan continued her assignment as a GAIN Services Worker (GSW) in the Homeless Case Management Program Unit at the Southwest Family CalWORKs district. She performed the duties of a Homeless Case Manager (HCM) under the supervision of the rater, Terry McKinney. While under Ms. McKinney’s supervision, Ms. Gezalyan was primarily responsible for assessing the needs of homeless and at-risk of being homeless families applying for/or already receiving CalWORKs,…

individual care plan for each participant, (4) putting the care plan into action, and (5) monitoring of results. In addition, Case management can be delivered as a single intervention or as part of a multicomponent intervention (e.g., disease management).On the other hand, Network Health offers integrated case management program. Network Health’s integrated case management program offers a holistic, multi-disciplinary approach to managing health care services for members with complex care needs…