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Running head: AN ALYSIS OF MANAGED CARE1An Analysis of Managed Care and It’s Use in Nontraditional Settings, the Impact on Access andPromoting HealthJames F. FallsColorado Technical University
AN ANALYSIS OF MANAGED CARE 2An Analysis of Managed Care and It’s Use in Nontraditional Settings, the Impact on Access andPromoting HealthManaged Care can be rudimentarily defined as a philosophy where the end state is a system that delivers quality, low cost health care by reducing redundant services, monitoring and controlling price of those services, controlling volume and focusing on prevention and education of the patient. Managed care can be traced back as early as the late 1920’s when a doctor by the name of Michael Shadid began a health cooperative for farmers in Oklahoma. His efforts created the ground work for what we know as today’s modern managed care model or Health Maintenance Organization (HMO). The most significant change in recent years was the signing of the Health Maintenance Organization Act of 1973. When President Nixon signed this act he was cutting off the Democratic Party’s attempt from developing a universal health care system. If this act had not been signed we as a nation would probably have higher health care cost and potentially higher taxes to pay for health insurance that others people could not afford (The Origins of Managed Health Care, 2016). Since the late 1980s the percentage of managed care enrolled patients has risen from approximately 27% to around 90% in 2008. Prior to this rise in managed care, fee for services was the dominate method of paying for health care. Managed care integrates finance, insurance, delivery and payment under one umbrella. Financing is a signed contract between the employer/organization and the hospital or health care provider. Insurance is not like typical insurance. By some opinions it is not insurance at all. The ManagedCare Organization handles everything that the insurance company would and assumes all risk involved. Delivery of care is through a network of approved providers. Members of the MCO have to choose from the list of contracted providers to seek care. If they require any referrals or specialty care they have to obtain a referral from their primary care manager (Shi & Singh,
AN ANALYSIS OF MANAGED CARE 32015). This gatekeeper function helps to keep cost down and control how health care is delivered. Delivery Method, Outpatient and nontraditional settingManaged care is designed to do several things for health care. One of the first thing managed care does is control cost. Patients pay a set monthly fee. Managed care organizations buy services in bulk for a larger number of people at one time. This is how they get care at a reduced cost.