Wait a second!
More handpicked essays just for you.
More handpicked essays just for you.
Components of management of quality in health care
Historical development in healthcare
Don’t take our word for it - see why 10 million students trust us with their essay needs.
Recommended: Components of management of quality in health care
Managed Care: Explored Although the concept of managed care has been in existence for several decades, Nickitas, Middaugh, and Aries (2016) remarked that its application in the nation’s healthcare system did not begin until the mid-1990s. Sekhri (2000) defined managed care as the variety of arrangements that incorporates the funding and delivery of care. Designed primarily to reduce the healthcare cost and deliver a high quality of care, Sekhri (2000) cited that managed care was criticized for its cost savings, provider reimbursement, and quality of care. To understand further, Sekhri (2000) explored that under the managed care system, the entire services – primary, secondary, tertiary- are monitored and coordinated to ensure appropriate
Membership Services (MSD) at Kaiser Permanente used to be a modest department of sixty staff. However, over the past few years the department has doubled in size, creating minor departmental reorganization. In addition the increase of departmental staffing, several challenges became apparent. The changes included primary job function, as well as the introduction of new network system software which slowed down the processes of other departments. These departments included Claims (who pay the bills for service providers outside of the Kaiser Permanente network), and Patient Business Services (who send invoices to members for services received within Kaiser Permanente). Due to the unforeseen challenges created by the system upgrade, it was decided that MSD would process the calls for both of the affected departments. Unfortunately, this created a catastrophic event of MSD receiving numerous phone calls from upset members—who had received bills a year after the service had been provided. The average Monday call volume had risen from 1,800 to 2,600 calls per day. The average handling time for each phone call had risen as well—from an acceptable standard of 5.6 minutes to an unfavorable 7.2 minutes. The department continued to be kept inundated with these types of calls for the two years that these changes have been effect.
To guarantee that its members receive appropriate, high level quality care in a cost-effective manner, each managed care organization (MCO) tailors its networks according to the characteristics of the providers, consumers, and competitors in a specific market. Other considerations for creating the network are the managed care organization's own goals for quality, accessibility, cost savings, and member satisfaction. Strategic planning for networks is a continuing process. In addition to an initial evaluation of its markets and goals, the managed care organization must periodically reevaluate its target markets and objectives. After reviewing the markets, then the organization must modify its network strategies accordingly to remain competitive in the rapidly changing healthcare industry. Coventry Health Care, Inc and its affiliated companies recognize the importance of developing and managing an adequate network of qualified providers to serve the need of customers and enrolled members (Coventry Health Care Intranet, Creasy and Spath, http://cvtynet/ ). "A central goal of managed care is containing the costs of delivering care, but the wide variety of organizations typically lumped together under the umbrella of managed care pursue this goal using combination of numerous strategies that vary from market to market and from organization to organization" (Baker , 2000, p.2).
Managed care reimbursement models have contributed to risk avoidance by negotiating discounts, discouraging use, and denying payments for charges that appear to be false. Health care reform has increased awareness to the quality of care providers give, thus shifting the responsibility onto the provider to provide quality care or else be forced to receive reduced reimbursements (Buff & Terrell,
Davidson, Stephen M. Still Broken: Understanding the U.S. Health Care System. Stanford, CA: Stanford Business, 2010. Print.
When one examines managed health care and the hospitals that provide the care, a degree of variation is found in the treatment and care of their patients. This variation can be between hospitals or even between physicians within a health care network. For managed care companies the variation may be beneficial. This may provide them with opportunities to save money when it comes to paying for their policy holder’s care, however this large variation may also be detrimental to the insurance company. This would fall into the category of management of utilization, if hospitals and managed care organizations can control treatment utilization, they can control premium costs for both themselves and their customers (Rodwin 1996). If health care organizations can implement prevention as a way to warrant good health with their consumers, insurance companies can also illuminate unnecessary health care. These are just a few examples of how the health care industry can help benefit their patients, but that does not mean every issue involving physician over utilization or quality of care is erased because there is a management mechanism set in place.
Twenty-first century health care system in United States is not only complex, but also profoundly different from "what it used to be." The changes are numerous and represent the major shifts involved in moving from protection and delivery plan, based primarily on what the patient wanted, to a skeptically managed healthcare system. The American health care system has seen drastic changes within couple generations and it continues to evolve.
Formed in 1998, the Managed Care Executive Group (MCEG) is a national organization of U.S. senior health executives who provide an open exchange of shared resources by discussing issues which are currently faced by health care organizations. In the fall of 2011, 61 organizations, which represented 90 responders, ranked the top ten strategic issues for 2012. Although the issues were ranked according to their priority, this report discusses the top three issues which I believe to be the most significant due to the need for competitive and inter-related products, quality care and cost containment.
Three areas that define the provisions of comprehensive health care services and are commonly used for utilization monitoring and control are gatekeeping, case management, and utilization review (UR). Gatekeeping is used by HMOs where each member designates a primary care provider (PCP) that is responsible for coordinating all care services needed for the enrollee in a managed care plan. Case management involves an experienced health care professional with knowledge of available health care resources. `Case management services are designed to identify spec...
The U.S. expends far more on healthcare than any other country in the world, yet we get fewer benefits, less than ideal health outcomes, and a lot of dissatisfaction manifested by unequal access, the significant numbers of uninsured and underinsured Americans, uneven quality, and unconstrained wastes. The financing of healthcare is also complicated, as there is no single payer system and payment schemes vary across payors and providers.
Americans these days need an affordable universal health insurance from the American government , Can the government give what the people need ? First of all many americans owe the government cause they can’t afford their medications , Second of all is Obama care really is worth it ? , Furthermore the US’s medical System is not working for most of the people who is on medication. US spends far and away more on healthcare than any other. Half of the americans are uninsured by the government. Over Half of the american population hasn’t gotten their Insurance and even if they do they still pay a lot of money for their medication.
In sum, America needs to reevaluate the status quo surrounding medical care. It is becoming increasingly apparent that the current model only benefits a select few and causes insufferable costs for the rest of the world. If there is no reform for these issues, money will continue to be siphoned directly into the pockets of large, for-profit companies that benefit from the strife of
What is managed care? According to the Oxford English Dictionary, managed care is “a system of health care in which patients agree to visit only certain doctors and hospitals, and in which the cost of treatment is monitored by a managing company.” Managed care is a variety of techniques designed to reduce the cost of providing health benefits and advance the quality of care. In the United States alone, there are various managed care programs, that are ranged from more restrictive to less restrictive. As stated in the National Institutes of Health, the future of managed care is uncertain. It is enthralling to note that in spite of the advances in healthcare systems, such as our hospital’s ability to provide patients with lower cost, managed
Managed care consists of HMO’s, PPO’s, IPA‘s, PSO‘s, and the PHO’s. Managed care is an insurance that goes along with financing and quality health care. Medicaid and HMO’s one of the biggest problems is finding doctors that are in the network on which means doctors that are members of the health plan. These are afford to help lower expenses and help to get quality care.
The federal and state governments are trying to find a way to managed their Medicaid by reducing costs and improving the amount of quality the Medicaid provides. Both federal and state governments are trying to eliminate unnecessary services and rely more on their primary care and the coordination of care. sta...
- Organisation and Management of Health Care, April 2002, Version 2.0 , Main Contributor: Katie Enock, Public Health Specialist, Harrow Primary Care Trust www.healthknowledge.org.uk