Managed Care Trends/Issues Analysis

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Managed Care Trends/Issue Analysis

Prepare a five-page paper in
which you research and evaluate what you believe to be the top three most
significant trends/ issues in managed
care
today. Justify, providing explanations for your three
choices. Include three to five reference sources (excluding the course text)
that have been written within the past three to five years.

[Instructor’s Tips]

This assignment does ask you
about the top three most significant trends/ issues in managed care
today (2018). Managed care should refer to a variety of
approaches intended to reduce the cost of providing health benefits, coordinate
better care, and improve the quality of care.

Managed
care is not interchangeable with managed care organizations such as HMOs, PPOs
or POSs. Managed care is also not interchangeable with the U.S. healthcare
delivery system. I used to work for Magellan, the largest managed behavioral
healthcare organization in the US. Magellan is not an insurance company.
Magellan is a managed
care organization
that manages mental/behavior health
benefits for Medicare, Medicaid, and major insurance companies that offer HMO,
PPO, POS, and indemnity plans. Magellan also manages employee assistance
programs for many Fortune 500 companies. Magellan has employed utilization
review and case management to control the cost of mental/behavioral healthcare
and ensure that quality of mental/behavioral healthcare is provided to the
patients.

Have you heard
about disease management that is one main essence of managed care? Have you
heard about health wellness programs? Under the Affordable Care Act,
managed care organizations have promoted health wellness programs intensively.
Have you heard about utilization review? Have you heard about case
management? Have you ever heard about Accountable Care Organizations
(ACOs) or patient-centered medical homes? ACOs and patient-centered
medical homes are new managed care models. Are they similar to HMOs, but they
are not the same. HMOs focus on control costs, while ACOs and patient-centered
medical homes have an emphasis on improving quality of care with evidence-based
practices. Once improving quality of care is done correctly with evidence-based
practices, the cost of providing healthcare will be reduced.

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