Lecture 7 Evolution of Managed Care

Lecture 7 Evolution of Managed Care - Evolution of Managed...

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Evolution of Managed Care Evolution of Managed Care PPD 230 Frankie Augustin
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REVIEW…. . REVIEW…. . What does EMTALA stand for? What is EMTALA? What is the difference between the prospective payment system  and the retrospective payment system? What is the main goal  for changing the reimbursement methods for the current  system? At minimum how many beds must a hospital have? For a hospital, what three main entities make up the triad of  power for governance? What is the growth in health care expenditures caused by? Who are the primary purchasers of healthcare? What is fee for service? What is the difference between copay and deductible? What are “dual eligibles”? Give an example. What is capitation?  Steinberg, Alan J. M.D., The Insider’s Guide to  HMOs
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Managed care defined… Managed care defined…     A mechanism of providing health care  services in which a single organization  takes on the management of financing,  insurance, delivery, and payment. System
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Managed care defined… Managed care defined…    Health insurance that utilizes management  and oversight of the medical services  provided by contracted physicians and other  providers in order to reduce inappropriate  services, increasing the quality of care, and,  in doing so, reducing costs.   Managed care encompasses HMOs, PPOs, POS. Steinberg, Alan J. M.D., The Insider’s Guide to  HMOs
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How it all started… How it all started… 1950’s-Beginning of technological  advances and continued every  succeeding year.   Hospitals became high-technology  centers, consuming excessive resources  on inpatient care Hospitals used billions to expand and  update facilities Fee for service galore
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It continues… It continues… Retrospective reimbursement  environment for inpatient care based on  per diem (daily) rates. Physician salaries went up. Specialists’ costs rose No restrictions and for limiting consumer use  No sense of cost for consumer
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But wait! There’s more… But wait! There’s more… ’ Mo Money, Mo’ Money, Mo’ Money! ’ Mo Money, Mo’ Money, Mo’ Money!
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  • Spring '05
  • Augustin
  • preferred provider organization, Health maintenance organization, HMO, Alan J. M.D., HMO HMO     PPO

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Lecture 7 Evolution of Managed Care - Evolution of Managed...

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