Managed care

It was a lofty goal by the government, one in which they invested more than $4.6 billion in grants and $1.5 billion in loans (Mantone, 2005). By 1980 the government had achieved its goal, but due to changes in reimbursement, the creation of managed care, and the closing of hospitals, the healthcare industry saw a steady decline in beds and the utilization of hospital services (Shi & Singh, 2015). Changes in Reimbursement…

Medical Advantage Plans There are many different types of insurance companies and different ways to pay health care providers. Choosing the appropriate health plan to fit your needs is where the work comes in. Choosing between fee-for-service, HMO’s, and PPO’s, is where it starts with Medicare advantage plans. Fee-for-service plans are when the provider is paid a set amount for each service provided according to his list of charges, also known as the fee schedule. There is no copay included.…

Coordinated Care Organizations and Accountable Care Organizations We will be comparing and contrasting Accountable Care Organizations and Coordinated Care Organizations. We will define and discuss what Accountable Care Organization and Coordinated Care Organization are. Also will discuss some of the other features to include providers, governance, and payments. One of their similarities is managing their patients and to decrease the cost from managed care. Even though Accountable Care…

Rising health care costs, a desire for increase access, and improvement in quality care, has the United States shifting focus to reform the health care delivery and payment systems. First there was pay for performance, then with the implementation of Affordable care act in 2010 began the payment reforms with concentration on care that was both quality based and cost effective. Emphasis was on decreasing thirty day readmissions for core measure diagnosis (Congestive Heart Failure, MI, and…

In today’s healthcare, case management ascends to an irreplaceable component in delivering quality care. The interaction of the case managers with multiple departments in a health system allows open communication, resulting in quality metrics demonstrating value in areas such as length of stay, observations, accounts receivable, and appeals or denials of patient care (Miodonski 2011). According to the Case Management Society of America (CMSA) hospital case management exists as a collaboration…

have the answers to what good patient care is for the patient. Patient- centered care though “is an understanding that patients must be asked to rate or judge their health care…” (Rickert, 2012). To put it in simple terms, patient centered care is a transition from doctors asking what’s wrong to asking what matters to the patients. The other part to patient centered care is about the relationship between healthcare providers and their patients. This type of care helps physicians determine what…

As demonstrated, many mergers have failed because the human and cultural side of integration is not managed as carefully as the financial and structural side. Furthermore, most mergers fail because the human and operational side of the integration is ignored because the two merging organizations do not thoroughly plan how to build on and integrate their…

quality and untimely heath care service delivery, inadequate education and poor information flow can be blamed on the system and the lack of inadequate awareness and efforts to address certain fundamental health issues. How the Florida Office of Minority Health currently serves…

hands, no indoor plumbing and raw sewerage running through the streets, leeches as part of care…it almost sounds like a horror movie; but this is a fairly accurate description of early hospital care throughout the world. Originally known as ‘houses of God’ most of these primitive hospitals were little more than a few beds to provide care to the ill, infirm and insane who had no family or means for other care (Gormley, 2010). Between 1860 and 1930 a number of “almshouses”, the predecessors to…

enjoyed the best health outcomes in the world; however, according to the World Health Organization the United States health system ranks 37th of the surveyed countries worldwide (Colorado State University-Global Campus, 2014). This is one reason many managed care organizations offer case management to achieve optimal wellness for their members while reducing costs. The following information comes from the unique perspective of a case manager…