Healthcare System Managed Care Analysis Paper
Managed care has contributed to the transformation of health care delivery across the nation. While managed care originated in the United States, its delivery style has spread internationally. Managed care can be discussed in two different contexts. The first framework describes an approach to health care delivery and is described as the integration of the financing, insurance, delivery, and payment functions within an organizational setting (Shi and Singh, 2019, p. 4). The second term could refer to a physical Managed Care Organization (MCO) which could be different settings (Shi and Singh, 2019, p. 361). The Affordable Care Act (ACA) of 2010, a health care reform initiative, is enriched with managed care strategies. After reading the background information, conduct additional research and respond to the following questions.
Watch the following videos in preparation for this assignment:
NY State of Health (2016, January 12). Health Insurance Explained
H. S. Rexburg (2016, October 19). Accreditation of health care
Use what you learned from the videos, the module’s required readings, and your own research to answer the following questions in your paper.
- What is managed care and how did it evolve?
- Discuss the current state of managed care in the U. S. Health system. Describe two efficiencies and two inefficiencies in managed care.
- Why is it important for policy makers and health care managers to understand the intricacies of the health care delivery system?
- Briefly describe some impacts of health care reform initiatives on managed care in the U.S.
Length: Submit a 3- to 4-page paper, not including the cover page and the reference list.
I’ve attached files and links below for additional reading for this topic. Thank you.
Ash, A. S., Mick, E. O., Ellis, R. P., Kiefe, C. I., Allison, J. J., & Clark, M. A. (2017). Social determinants of health in managed care payment formulas. JAMA Internal Medicine, 177(10), 1424-1430.
Bachrach, D., Guyer, J., Meier, S., Meerschaert, J., & Brandel, S. (2018). Enabling sustainable investment in social interventions: A review of Medicaid managed care rate-setting tools. Retrieved from https://www.commonwealthfund.org/publications/fund-reports/2018/jan/enabling-sustainable-investment-social-interventions-review
Bindman A. Redesigning Medicaid managed care. (2018). Journal of the American Medical Association, 319(15), 1537–1538. doi:10.1001/jama.2018.3411
Hines, A. L., Raetzman, S. O., Barrett, M. L., Moy, E., & Andrews, R. M. (2017). Managed care and inpatient mortality in adults: Effect of primary payer. BMC Health Services Research, 17(1), 121.
Ndumele, C. D., Schpero, W. L., Schlesinger, M. J., & Trivedi, A. N. (2017). Association between health plan exit from Medicaid managed care and quality of care, 2006-2014. Journal of the American Medical Association, 317(24), 2524-2531
Yeung, K., Suh, K., Basu, A., Garrison, L. P., Bansal, A., & Carlson, J. J. (2017). Paying for cures: How can we afford it? Managed care pharmacy stakeholder perceptions of policy options to address affordability of prescription drugs. Journal of Managed Care & Specialty Pharmacy, 23(10), 1084-1090.