Managed Care Trends/Issue Analysis
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Managed Care Trends/Issue Analysis
What is managed care?
Managed care has been incorporated in the health sector for quite some time now. Many providers of health care like Medicaid and Medicare have been using this approach in the provision of the health services. In fact, Medicaid has 70% of its enrollees accessing health care through this approach. Managed care incorporates an approach for delivery and financing of health care with the prime goal of enhancing the quality of these services while saving on the costs incurred in their provision (Bobby, 2011). This was based on the notion of improving the health care access as well as coordination through giving an assurance about the comfort of the enrollees in this facility while also heavily relying on the preventive and primary care.
As we will acknowledge, managed care has been undergoing tremendous changes from the traditional way it used to operate. Many would attribute this to some failure it has known in the past as there were lessons learnt as well as from the successes the approach has undergone. Since its inception, managed Care has seen tremendous growth in the number of enrollees. Generally, managed care incorporates three plans. These are the Health Maintenance Organization (HMO), Preferred Provider Organizations (PPO) and Point of Service plans (POS). For all of them, there is financing for health care though the conditions will differ as well as the percentage financed.
Trends in the managed care industry
As we will acknowledge, the managed care industry has been guided by some objectives. These included the satisfaction of the enrollees through improving health care access, containing costs through minimizing the expenses and increasing revenue and provision of health care in high standards. While many would acknowledge the importance of the plan and even call it successful, an equally high number hold a different view. There has been a consensus however, that success should be evaluated in terms of value provided to the enrollees or customers. As much as value is also determined by an individual organization’s philosophy, there is a general agreement that it has to be seen as a blend of three important aspects that are satisfaction, quality and cost. The trends are based on these three pillars (Bobby, 2011).
However, the definition of optimal relationship will also vary between the organizations. As we would acknowledge, these aspects are connected to each other. It would only be important to reduce the cost of health care while taking care not to compromise on the satisfaction derived from the provision of quality health. In addition, choosing between enhancing quality and satisfaction would be guided by the option that brings about the largest savings on the cost of health care. There has to be a threshold as to the satisfaction, and quality levels an organization would not go below without giving up its functionality (Mark, 2009). This underlines the fact that the optimization of these aspects would only be gauged by how they blend to enhance profitability both in the short term as well as in the long term. The implications of the aspects have been considered in the managed care plans as the trends have been followed. Therefore, the following are the most important issues.
The satisfaction of the enrollees
The satisfaction of the enrollees especially as pertaining to the accessibility to healthcare has become an issue in the managed care industry. This is contrary to the previous focus that was placed on containing the costs as well as lowering the premiums from the buyers (Brian, 2010). This is evidenced by the multiple legislative initiatives undertaken to enhance accessibility to healthcare. In addition, there has been intense pressure on the government due to the disenchantment of the voters with the managed care plans.
The importance of this particular trend is indicated by the implications it has on the operations of the managed care plan. To start with, it indicates that the industry has been viewed as a for profit business incorporating insensitivity to buyers and patients seeking healthcare.
In this case, this trend underlines the importance of the managed care industry marketing programs that it has to buyers as well as the enrollees with the intention of differentiating its plans from the others. In this trend, there is an emphasis on an appeal mechanism while the enrollees have the right to be informed as pertaining to alternative treatment (Brian, 2010). In addition, there is the idea of making the systems friendlier to the patients through offering more far-reaching blend, admission review, and number as well as authorization procedures of the emergency department. All these are bound to enhance the satisfaction of the patients or the enrollees. This is in line with the objectives of the organization as well as the plans.
Containing the cost
As we will acknowledge, the basis of the managed care plans is the reduction of health care cost to the employers as well as the employees. The industry has had its fair share of success in this endeavor until recently (Willy, 2010). The success was responsible for the transformation of many employees to the managed care program. However, this endeavor has faced serious challenges leading to the revision of the program by some organizations. In fact, there have been reports of many employers having increases by as much as 20 percent. The rise in the costs of health care provision has been attributed to the incorporation of new technology in these services.
As we will acknowledge, the trend pertaining to containing the cost of the health care services has a bearing on the quality of the managed care advanced to the enrollees. This underlines the importance of looking into this trend carefully to ensure that there is no compromise on the quality (Willy, 2010).
Improvement of the quality of the services provided by the managed care
Previously, quality as a major issue for enrollees and employers has been relegated to the backstage. This is mainly due to the assumption that the quality of managed care services will still be safeguarded even as the costs are reduced and accessibility of healthcare services boosted. However, this has been proven untrue because an increase in the accessibility of health cost and the reduction of their cost has been the industry’s prime goal (Willy, 2010).
The importance of improving the quality of the services provided by the managed care cannot be gainsaid. This pertains to retraining of the physicians especially on issues pertaining to customer handling. In addition, there would be a need to incorporate the use of new high-tech equipment to improve the quality. As much as these may initially appear costly, they will lead to more efficiency in the long term thus reducing the cost and therefore, leading to more customer satisfaction.
Conclusion
One would acknowledge that these trends are long overdue. There has been many issues pertaining to buyer dissatisfaction with the services availed by the managed care plans. However, the current trends have transformed the industry quality orientation, driven by values while acknowledging that the high quality of the health care would be cost effective in the long term.
References
Willy, R. (2010). Health Care. Managed Health Care Problem Analysis, 17(40), 7-21.
Mark, L. (2009). Management. Managed-Care Health Solutions, 25(30), 2-10.
Brian, G. A. (2010). Medicaid Issues. Journal of Health Management, 45, 692-722.
Bobby, C., IV. (2011, May 3). Managed Care services. Times, 225, 15-24.
