Managed Care Trends/Issues Analysis

Managed Care Trends/Issue Analysis

Prepare a five-page paper in which you research and evaluate what you believe to be the top three most significant trends/ issues in managed care today. Justify, providing explanations for your three choices. Include three to five reference sources (excluding the course text) that have been written within the past three to five years.

[Instructor’s Tips]

This assignment does ask you about the top three most significant trends/ issues in managed care today (2018). Managed care should refer to a variety of approaches intended to reduce the cost of providing health benefits, coordinate better care, and improve the quality of care.

Managed care is not interchangeable with managed care organizations such as HMOs, PPOs or POSs. Managed care is also not interchangeable with the U.S. healthcare delivery system. I used to work for Magellan, the largest managed behavioral healthcare organization in the US. Magellan is not an insurance company. Magellan is a managed care organization that manages mental/behavior health benefits for Medicare, Medicaid, and major insurance companies that offer HMO, PPO, POS, and indemnity plans. Magellan also manages employee assistance programs for many Fortune 500 companies. Magellan has employed utilization review and case management to control the cost of mental/behavioral healthcare and ensure that quality of mental/behavioral healthcare is provided to the patients.

Have you heard about disease management that is one main essence of managed care? Have you heard about health wellness programs? Under the Affordable Care Act, managed care organizations have promoted health wellness programs intensively. Have you heard about utilization review? Have you heard about case management? Have you ever heard about Accountable Care Organizations (ACOs) or patient-centered medical homes? ACOs and patient-centered medical homes are new managed care models. Are they similar to HMOs, but they are not the same. HMOs focus on control costs, while ACOs and patient-centered medical homes have an emphasis on improving quality of care with evidence-based practices. Once improving quality of care is done correctly with evidence-based practices, the cost of providing healthcare will be reduced.