The Role of Managed Care and Other Models for Reimbursement
The U.S. adopted managed care in its public in the past centuries. Managed care is a healthcare service in which the government coordinates healthcare services through legislation. Quality and cost of medical expenses coordinating the provision of healthcare services. The U.S. government uses a payment process that reimburses hospitals that provide preventive care to patients. Subsidized medical services are developed strategically by the U.S. health department. Managed care ensures that the public receives basic medical services from qualified medical practitioners. This healthcare framework also ensures that healthcare institutions are reimbursed appropriately. The role of managed care is important in providing quality medical services and affordable health insurance covers.
There are several types of managed care plans that Healing Hands Hospital could assess. The Preferred Provider Organizations (PPO) is a type of managed care plan in which a patient is allowed to choose their primary doctor. This medical practitioner is assigned the duty of providing medical services to a certain patient (Khullar, et al. 2016). The primary doctor ensures that a patient recovers from an illness and maintains their medical records. A primary doctor plays a key role in improving medical services and reducing healthcare cost. For instance, it is through preventive care by a primary doctor that medical intervention is timely applied to an illness before it gets to chronic levels.
Advanced illnesses increase healthcare expenses such as access to costly medical services. Health Maintenance Organizations (HMO) is another type of managed care plan that allows the public to choose medical services that suit an individual. HMO requires clients to pay more for medical services than PPO patients (Durbin, et al. 2016). Health institutions that provide HMO plans allow clients to select primary care providers from a pool of experienced medical practitioners. Qualified doctors and nurses are expected to provide healthcare services to all clients assigned to them. The quality of preventive care among HMO clients is higher than for patients under PPO covers.
Healing Hands Hospital would benefit from managed care plans that achieve quality medical services at an affordable cost to the public. It is through managed care that the hospital would expand its scale of operation as a business entity. For instance, increased reimbursements to PPO services among the public would indicate profitability at Healing Hands Hospital. Profit-making institutions strive to achieve high profitability by expanding operational scale (Khullar, et al. 2016). The hospital would also improve its medical services to suit new legislation and recommendation approved by the U.S. department health. Information on positive business impacts on healthcare providers and affordability of managed care plans would promote the American economy. Reducing healthcare cost through preventive care would paint a positive image for Healing Hands Hospital.
Managed care is a more viable reimbursement model for Healing Hands Hospital than; Accountable Care Organization (ACO) model and Value-Based reimbursement. Accountable Care Organizations model restricts access to medical services to the public. Patients can only access subsidized medical services in registered hospitals (Khullar, et al. 2016). This is an inconvenient model of providing quality care as a patient might not benefit from medical services provided if they change residence. ACO’s model has an inferior reimbursement process than managed care plans as payment processes are uncertain in some instances. There are situations when a hospital lacks medicine to treat preventive care and end up referring patients to other healthcare institutions.
The Value-Based reimbursement model determines healthcare provision that is based on qualitative and quantitative factors of medical services. Doctors agree on a payment framework which puts into account medical cost of a patient (Durbin, et al. 2016). The value-based model depends on standardized processes that include key stakeholders of the medical sector in the U.S. These would include doctors, nurses, public representatives, and government officials. Coming into concession on the most viable reimbursement model is tedious and unattractive to many medical professionals. The future of managed care plans – will include doctors and nurses – that prefer direct negotiation with clients for medical services offered.
Laws that affect the quality of medical services and reimbursement procedures are important to Healing Hands Hospital. Improved medical services – that are included as part of preventive care for managed care plans – would affect the organizational image of the hospital. For instance, many patients who visit Healing Hands Hospital would attract more referrals for advanced medical services (Khullar, et al. 2016). A law that outlines new medical procedures in a managed care plan would oblige Healing Hands Hospital to oblige with new regulations. For instance, storage and access to personal details of patients would require an enhanced administrative practice in record keeping. Affordable Care Act would also affect the hospitals budget when new medical services are included in a managed care plan.
Managed care plans should consider several factors that relate to an individual directly. Preventive care and access to antibiotics is a strategic plan that reduces the entire cost of medical services. The U.S. government ensures that approved managed care plans improve the level of healthcare services. Managed care plans have enabled Americans to access preventive care from public health institutions. Most managed care plans in the U.S. meet the basic objective of promoting business to hospitals and providing quality medical care to the public. The cost of accessing healthcare services is subsidized to levels the suit the American economy. Health insurance providers are also encouraged to come up with managed care plans that suit the economy in terms of affordability.
Khullar, D., Rao, S. K., Chaguturu, S. K., & Rajkumar, R. (2016). The evolving role of subspecialties in population health management and new healthcare delivery models. Am J Manag Care, 22(6), e192-e195.
Durbin, A., Durbin, J., Hensel, J. M., & Deber, R. (2016). Barriers and enablers to integrating mental health into primary care: a policy analysis. The journal of behavioral health services & research, 43(1), 127-139.