1000+ documents containing “managed care”.
Managed Care is an approach or system of health care that manages the use of healthcare services, controls their costs, and evaluates the performance of healthcare providers. It is also considered as an approach to funding and providing healthcare services which focuses on controlling costs and enhancing the quality of care through several methods. Some of these methods that are used in managed care to help accomplish the described objectives include quality assurance, utilization management, and provider network management. Notably, the likelihood of managed care to enhance quality, accessibility, and plans of healthcare services depends on various factors.
In today's health care system, managed care plans exist in various types with the two common types being Health Maintenance Organizations and Preferred Provider Organizations. While most of the other types of managed care plans being hybrids of the two, individuals are required to know the details of their specific managed care plans.….
Boyle, B., Deaton, D. & Maddigan, M. (2010, March 30). United States: The Health Care
Reform Legislation and its Impact on the Health Care and Life Sciences Industries. Retrieved September 24, 2011, from http://www.mondaq.com/unitedstates/article.asp?articleid=97086
Carlson, G. (2009, May 5). Managed Care: Understanding Our Changing Health Care System.
Retrieved September 24, 2011, from http://missourifamilies.org/features/healtharticles/health39.htm
The reluctance to refer patients to specialists may also mean that nurses must practice more holistic, rather than specialized forms, of nursing. The desire for cost containment has resulted in many nurses assuming physician's duties, such as those duties confined in previous eras to the patient's primary care physician. In states with high HMO (Health Maintenance Organization) enrollment, more nurses were shifted to lower-paying nonhospital settings, such as in home health care settings, to defray costs (Buerhaus & Staiger 1996).
hat affect has manage care had on nursing education?
Surprisingly, the majority of nursing schools still do not work with a managed care organization or with physician training programs to facilitate educating student nurses in managed care competencies. However, 57% of hospitals do offer continuing education to staff members though educational seminars, staff meetings, and other programs (Copeland 2003, p.2-3). Although the managed care system is likely to change in the not-so-distant….
• •the marketplace lacks competition. Thus the consumer may have limited choice, and some sellers or manufacturers may not care if the consumer is dissatisfied. (Zelman, 1999, pp. 5-6)
Managed care, then becomes an institution that is highly in need of regulation, according to those who make such decisions, as the need to be a consumer advocate (including those who are profiting from health care) has always driven the government to act.
Lastly, the manner in which the managed care system has changed the way that sellers, in this case doctors, most of home have historically been in private practice, with clinical privileges to practice care in most of the local hospitals where they work. Doctors who have been in practice for years are seeking change and regulation within the managed care system, as many are reluctant to center their new lives around a salary and a job (as they were always….
Birenbaum, a. (1997). Managed Care: Made in America. Westport, CT: Praeger Publishers.
Folta, J., & Scanlon, J. (2004, April). Community Health Care Reform: Introducing the 100%/0 Campaign. Public Management, 86, 26.
Pauly, M., & Berger, M.L. (1999). Chapter Three Why Should Managed Care Be Regulated?. In Regulating Managed Care: Theory, Practice, and Future Options, Altman, S.H., Reinhardt, U.E., & Shactman, D. (Eds.) (pp. 53-74). San Francisco: Jossey-Bass.
d.). Accreditation is basically important for various functions such as promoting the quality of healthcare delivered to consumers and other purchasers of care. Secondly, the accreditation is important because it helps health care organizations and facilities to recruit and retain qualified practitioners. This in turn enhances organizational efficiencies to lessen costs, identify means for enhancing service delivery, and lessening liability insurance premiums.
Organizations that Accredit Managed Care Organizations in America:
There are various types of accreditation processes that are used for healthcare practitioner and facilities in the United States. This is primarily because the specifics about the process and its subsequent procedures may differ based on the specific area within the health care field. In the managed care field, there are various organizations that accredit managed care in the United States such as
Joint Commission on Accreditation of Healthcare Organizations:
This organization is the quality oversight body for all healthcare organizations and managed care….
Managed Care Plans
Analyze how the policies and practices related to Managed Care Plans can influence the activities of managers in health services organizations.
Over the last several years, the role of health care organizations has been continually evolving. Part of the reason for this, is because costs have been rising exponentially. Evidence of this can be seen with a survey that was conducted by the Kaiser Foundation. They determined that over the course of one year, health insurance premiums have increased by 14%. This is a part of a larger effort, to deal with rising costs at a variety of health care organizations. (Ableson, 2010)
As a result, a shift has occurred in the kinds of services that are being provided to consumers. This has lead to a transformation in the policies and procedures at managed care plans. To fully comprehend how these shifts are occurring requires examining: the different ways they….
Definition Managed Care. (2011). Med Terms. Retrieved from: http://www.medterms.com/script/main/art.asp?articlekey=4270
Ableson, R. (2010). Employees Push Costs. NY Times. Retrieved from: http://www.nytimes.com/2010/09/03/business/03insure.html
Beam, B. (2005). Employee Benefits. Southfield, MA: Readings for the Blind.
Duncan, W. (1997). Handbook of Health Care Management. Malden, MA: Blackwell
Managed Care Organzations. (MCO)
Since the increasing costs of health care insurance became a significant issue in the profitability of health care provider in the 1980's health care provider, insurance companies, doctors and hospitals have searched for creative ways to cut costs while not sacrificing care qualitative. What has evolved in the health care industry is a shopping list of various organizations which offer health care services. The different organizations all address the issues within the health care industry with slightly different priorities. As a result, as a company, we have to determine which priorities are important to our group, and to our employees. We need to evaluate the levels of care, costs management, universal availability and quality of care which we are willing to pay for. The result of this process will be that the health care organization which is most appropriate for our organization will be fairly self evident.
Kongstvedt, P. (2001) Essentials in Managed Health Care. Maryland: Aspen Publishers.
Mercer, W. (No date) Continuum of Managed Care. California: William Mercer Inc.
Roussel, H. (1999) HMO Enrollment in Millions. HMO Digest Series. HMO-PPO Digest. SMG marketing group.
Pharmacists polled on managed care. (on the benefits and drawbacks of managed health care) (1991, Dec. 9) Chain Drug Review.
Managed Care Timeline
Luke Medical Center, Pasadena, California - established
The change in hospital concentration in 68 large metropolitan statistical areas (MSAs) between 1981 and 1994 is positively correlated with the level of managed care concentration in 1993/1994.
Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of patients' ability to pay.
4,908 hospitals in the United States have Emergency Departments.
Crowded emergency departments arise because state and federal governments are not providing enough support to public hospitals.
Nearly 18% of hospitals with Emergency Departments (1out of 5) were shut down, according to figures provided by the American Hospital Association.
2001 -- 4,045 hospitals in the United States have Emergency Departments, a drop of 863.
2002 -- Emory Parkway Medical Center, Atlanta, Georgia -- closed. Cause: After 28 years, excluded from participation in some managed care plans.
2002 -- St. Luke Medical Center, Pasedena, California -- closed. Cause: Weak managed….
____. (2012, December). Trends in nursing facility characteristics. American Health Care Association Reimbursement and Research Department.
Glabman, M. (2003, June). Managed care makes it tough for some hospitals to stay afloat. Managed Care. Retrieved http://www.managedcaremag.com / archives/0306/0306.er.html
Town, R.J., Wholey, D., Feldman, R. & Burns, L.R. (2007). Revisiting the relationship between managed care and hospital consolidation. Health Services Resources 42(1 Pt 1), 219-238. doi: 10.1111/j.1475-6773.2006.00601.x Retrieved http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1955242/
Doctors too are crippled and pressured by managed care organizations that tend to influence their decisions. Today, Managed care presents an unhealthy prospect and the future for such an unethical, unprofessional and profiteering approach is rather bleak. Under these circumstances of growing public remorse and rancour, it seems rightful for the government to intervene and set right an ailing system which threatens the very object of managed care: that of providing quality medical care. Thus, the future for managed care as it is today, is really bleak and a change is imminent and urgent. It is hoped that a single player system would finally be in place. The bill introduced by Cong. John Conyers, if successfully passed, will create a new positive wave in American medical history.
Tufts management care Institute, " a rief History of Managed Care," Accessed April 25th 2007, available at http://www.thci.org/downloads/riefHist.pdf
Kaiser Permanente, "In the Desert a….
Tufts management care Institute, " a Brief History of Managed Care," Accessed April 25th 2007, available at http://www.thci.org/downloads/BriefHist.pdf
Kaiser Permanente, "In the Desert a New Kind of Health Care Begins," Accessed April 25th 2007, Available at http://newsmedia.kaiserpermanente.org/kpweb/historykp/entrypage.do
MCOL Inc., "Managed care Factsheets," Accessed April 26th 2007,
Available online at, http://www.mcareol.com/factshts/factplan.htm
One issue that has received a great deal of attention in recent months during the healthcare debate is the role of health insurance companies. Managed care was originally intended to lower costs within the American healthcare system to prevent overconsumption of health services that were unnecessary or of unproven value. However, the overall costs of the American healthcare system have increased rather than decreased in recent years, despite the rise of HMOs (health management organizations), as have the numbers of uninsured Americans unable to afford to buy health insurance. Many of these persons use the emergency room as their primary site of healthcare.
There is clear evidence that some Americans with high-quality health insurance are over-tested, despite the existence of HMOs. "Some research groups estimate that excessive, unnecessary testing and procedures account for as much as one-third of U.S. medical spending, which totaled more than $2 trillion in 2009 alone"….
Gann, Carrie. (2012). Doctors react to new testing recommendations. ABC News. Retrieved:
Girion, Lisa. (2009) California HMOs deny 1 in 5 claims. Los Angeles Times. Retrieved:
Likewise, the therapist in front of the mirror is expecting a credible "performance" that illuminates and furthers the therapeutic process (Johnson et al., 1997).
Solution-focused therapy encourages all participants to attend to their own wants and needs, not just those of their partners. Depending on the goal, therapists recommend that each participant take charge of caring for oneself as well as appreciating how his or her own actions influence others (Dermer et al., 1998).
Dermer et al. (19918) went further to express that solution-focused methods encourage clients to discuss ones desires and wishes at length but to do so in positive terms (such as through the "miracle question). Positive insights are encouraged, but negative insights are not. When clients complain and blame, the job of the therapist, is to redirect the conversation back toward searching for exceptions and use solution talk, rather than excluding insights, they selectively reinforced.
Solution-focused therapists' belief in….
Brooks, D.K., & Gerstein, L.H. (1990). Counselor credentialing and inter-professional collaboration. Journal of Counseling & Development, 68, 477-484.
Bubenzer, D.L., & West, J.D. (1993). Interview with William Hudson O'Hanlon: On seeking possibilities and solutions in therapy. The Family Journal, 1, 365-379.
De Shazer, S. (1991). Putting difference to work. New York: Norton.
Dermer, S.B., Hemesath, C.W., & Russell, C.S. (1998, Jul-Sep). A Feminist Critique of Solution-Focused Therapy. American Journal of Family Therapy, 26(3), 239-250.
Managed Care Organizations: Basics of Negotiating and Contracting
Managed care organizations, and corporations generally, have legal departments or law firms that zealously represent their interests. Consequently, in the managed care environment, practitioners need to be legally savvy when it comes to negotiation and contracting. The focus of this work in writing will be the negotiating and contracting in the managed care setting.
Three Basic Elements of a Contract
The entire U.S. economy is based on "the freedom of individuals to contract and a system of law that enforces contracts freely entered into." (Oilek, 2011) A contract is defined as "a voluntary, deliberate and legally binding agreement between two or competent parties. Contracts are usually written but may be spoken or implied, and generally have to do with employment, sale or lease, or tenancy." (Business Directory, 2011) There are three very basic and very essential elements to a contract that is legal and enforceable.….
Contract Basics (2010) McCandlish & Lillard, P.C. Legal Counsel. Retrieved from: http://www.mccandlaw.com/files/Contract%20Basics.pdf
Contract Negotiations as a Source of Value (2010) Contracting Excellence. International Association for Contract and Commercial Management. Upside Software Inc. May, June, July 2010. Retrieved from: http://www.iaccm.com/userfiles/file/CE_April2.pdf
Mazmi, Mahbub (2008) Effective Method of Negotiation. E-zine Articles. Retrieved from: http://ezinearticles.com/?Effective-Method-of-Negotiation&id=1671981
Oilek, Sucha S. (2010) Essential of a Contract. E-Law. Retrieved from: http://www.e-law.bc.ca/art_essential.html
managed care in modern health care. Specifically it will include a brief history of managed care, along with some pros and cons about the process.
Managed care is an arrangement where an insuring organization accepts the risk for providing a defined set of health services, using a defined set of providers, for a defined population, in return for a fixed or regular per capita payment" (Lammers and Geist, 1997, p. 46). Briefly, for managed care to survive and prosper, member physicians must do the minimum health care necessary to keep the patient healthy and still turn a profit.
Managed care is not a new phenomenon in health care. In fact, it has existed in the United States since the 1920s. "Historians cite the 1930s as the beginning of managed care as we know it today. The launch of the Kaiser Health Plan during World War II resulted in the first clinic-based….
Birenbaum, A. (1997). Managed Care: Made in America. Westport, CT: Praeger Publishers.
Cummingse, N.A. (1992). Case Vignette: the Vicissitudes of Managed Care. Ethics & Behavior, 2 (3), 215-226.
Editors. (2002). The History of Managed Care. Retrieved October 29, 2002, NCMIC Web site: http://www.ncmic.com/NCMIC_Ins/DoctorsOfChiro/PracticeTools/managed_care_sln/history.asp
Lammers, C., & Geist, P. (1997). The Transformation of Caring in the Light and Shadow of "Managed Care." Health Communication, 9(1), 45-60.
Nursing Tasks, Methods, And Expectations
State of the Industry
The Art and Science of Nursing
Relative Pay Scales
Male Nursing Roles
The Influence of the Nationalized Healthcare Debate
Proposed Methods toward Recruiting Nurses
Joint Corporate Campaigns
Steps to Recruiting Men
Recent employment trends in the nursing field have demonstrated a disconcerting drop in the number of employed and employable nurses. In what has been traditionally a female dominated filed, the exit rate of both men and women, as well as the approaching retirement of a majority of existing nurses, threaten the long-term care quality of hospital and other in-patient care facilities.
This paper examines some of the factors behind the current nursing shortage, and offers suggestions as to how to reverse the trends which, if left unchecked, threaten our nation's health care delivery system.
Since the days of Florence Nightingale, patients in hospitals around the world depend on the care of nurses. These trained professionals assist doctors and specialists….
Agovino, T. (06/01/2001) NURSES PLAY HARDBALL SHORTAGE SPURS LABOR TROUBLES.
Wisconsin State Journal.
Allen, D.G. (1996). Knowledge, politics, culture, and gender: A discourse perspective. Canadian Journal of Nursing Research, 28, 95-102.
Anand, Amit (2000, 14 April) Ex-Surgeon General Koop calls for universal care., University Wire.
managed care has now permeated the general atmosphere of health care and the healing process in society. The purpose of this essay is to discuss the evolution of managed care and its practices and how they impact profession of health care and its subsidiaries. This essay will include personal opinion on these impacts and discuss how managed care in its current status is not aligned with many of my beliefs and values.
Evolution of Managed Care
The nature of modern managed care is very invasive and permeates deeply throughout society and law. Managed care spans a wide range of entities, organizations and influences. They are often heavily regulated, managed and studied. Managed care entities have grown and evolved significantly in the past decades. There are many reasons to why managed care as evolved in this manner and how these causes have materialized into effects that have placed many challenges in the….
Deom, M., Agoritsas, T., Bovier, P.A., & Perneger, T.V. (2010). What doctors think about the impact of managed care tools on quality of care, costs, autonomy, and relations with patients. BMC health services research, 10(1), 331.
Feldstein, M. (2009). Obamacare is all about rationing. Wall Street Journal.
Long, S.K., & Coughlin, T.A. (2001). Impacts of Medicaid managed care on children. Health Services Research, 36(1 Pt 1), 7.
Sloan, F.A., & Hall, M.A. (2002). Market failures and the evolution of state regulation of managed care. Law and Contemporary Problems, 169-206.
, income is quite often decreased and patient care sometimes adversely impacted due to time constraints, the need to hire a dedicated insurance person for the office, and the innumerable and sometimes counter-productive, forms and questions the HMOs ask of their medical professionals (See: Zimet, 1989, 2002).
The survey instruments were both quantitative and qualitative in nature, and included four to six sections: basic demographics; general information about the practice (theoretical orientation, hours worked, staffing, etc.); basic locus of stress and attitudes towards practice; financial aspects of the practice; and a burnout inventory (designed to identify factors contributing to job or field burnout). Sample sets were then cross-tabulated and the results presented in tabular form, along with a robust discussion.
One of the aspects of the research was to infer the evolution of the practice in relation to managed care parameters. As expected, the study found that managed care often contributed to….
Managed Care is an approach or system of health care that manages the use of healthcare services, controls their costs, and evaluates the performance of healthcare providers. It is…Read Full Paper ❯
The reluctance to refer patients to specialists may also mean that nurses must practice more holistic, rather than specialized forms, of nursing. The desire for cost containment has resulted…Read Full Paper ❯
• •the marketplace lacks competition. Thus the consumer may have limited choice, and some sellers or manufacturers may not care if the consumer is dissatisfied. (Zelman, 1999, pp. 5-6) Managed…Read Full Paper ❯
d.). Accreditation is basically important for various functions such as promoting the quality of healthcare delivered to consumers and other purchasers of care. Secondly, the accreditation is important because…Read Full Paper ❯
Managed Care Plans Analyze how the policies and practices related to Managed Care Plans can influence the activities of managers in health services organizations. Over the last several years, the role…Read Full Paper ❯
Managed Care Organzations. (MCO) Since the increasing costs of health care insurance became a significant issue in the profitability of health care provider in the 1980's health care provider, insurance…Read Full Paper ❯
Managed Care Timeline Luke Medical Center, Pasadena, California - established The change in hospital concentration in 68 large metropolitan statistical areas (MSAs) between 1981 and 1994 is positively correlated with the…Read Full Paper ❯
Doctors too are crippled and pressured by managed care organizations that tend to influence their decisions. Today, Managed care presents an unhealthy prospect and the future for such…Read Full Paper ❯
Managed Care One issue that has received a great deal of attention in recent months during the healthcare debate is the role of health insurance companies. Managed care was originally…Read Full Paper ❯
Likewise, the therapist in front of the mirror is expecting a credible "performance" that illuminates and furthers the therapeutic process (Johnson et al., 1997). Solution-focused therapy encourages all participants…Read Full Paper ❯
Business - Law
Managed Care Organizations: Basics of Negotiating and Contracting Managed care organizations, and corporations generally, have legal departments or law firms that zealously represent their interests. Consequently, in the managed care…Read Full Paper ❯
managed care in modern health care. Specifically it will include a brief history of managed care, along with some pros and cons about the process. Managed care is an…Read Full Paper ❯
Health - Nursing
Nursing Tasks, Methods, And Expectations State of the Industry The Art and Science of Nursing Relative Pay Scales Male Nursing Roles Sex Stereotypes The Influence of the Nationalized Healthcare Debate Proposed Methods toward Recruiting Nurses Joint Corporate…Read Full Paper ❯
managed care has now permeated the general atmosphere of health care and the healing process in society. The purpose of this essay is to discuss the evolution of…Read Full Paper ❯
, income is quite often decreased and patient care sometimes adversely impacted due to time constraints, the need to hire a dedicated insurance person for the office, and the…Read Full Paper ❯