Types of Managed Care Plans: Preferred Provider Organisations (Essay Sample)

Managed Care
Name
Institution
Managed Care
Introduction
The term managed care refers to various healthcare insurance plans used in the United States aimed to moderate the cost of providing care to the citizens. Essentially, the techniques used are intended to enhance the quality of patient care provided in the medical facilities. The approaches also include the systems of financing to the enrolled organisations under the managed healthcare concept and techniques. In this essay, three types of managed care plans will be discussed. Furthermore, their impact on the way services are delivered at Healing Hands Hospital will be included. The paper will identify the changes that managed care has experienced over the last ten years and discuss the future for the approach as a viable reimbursement model for Healing Hands Hospital. Lastly, the paper will describe the impact of the Affordable Care Act and MACRA as regulations that influence reimbursement and patient care in Healing Hands Hospital. Managed Care model is a better compensation model compared to Accountable Care Organisation and Value Based approaches.
Types of Managed Care Plans
Preferred Provider Organisations
The PPO plan is designed as an arrangement with a particular system of hospitals, doctors and other healthcare providers that have contracted to accept low fees from their insurance providers. In that case, one’s cost sharing is usually lower compared to costs outside the network. The PPO arrangement allows the physicians to make referrals to members and individuals outside the plan (United Health Care, 2017). The Preferred Provider Organisation approach influences health care delivery in Healing Hands Hospital as the provision to seek direct treatment from the doctors helps in building patient volumes.
Health Maintenance Organisations
The model allows the members to receive various health benefits as long as they seek care from the facilities and institutions under the HMO network. The approach attracts monthly premiums and provides the carriers with preventive health care services such as hearing tests, annual check-ups and flu shots (United Health Care, 2017). HMO impacts patient care delivery at Healing Hospital as only resisted members are allowed to visit doctors in the institution.
Point of Service Plans
In this structure, the patients are allowed to obtain health care services outside the network. However, the individuals are required to cover large sums of deductibles (United Health Care, 2017). The approach influences health care delivery and the volumes of people seeking medical attention in Healing Hands Hospital as patients have the freedom to choose to receive services from physicians outside the facility.
Changes in Managed Care
Managed care has changed significantly over the last ten years. More so, the program has experienced modifications in health care spending, policy, and legislation. Ten years ago, the national health expenditures were reviewed depending on the aggregate economic trends (Martin, Hartman, Washington, Catlin & National Health Expenditure Accounts Team, 2016). Today, the managed care model has developed to ensure that the changing economic trends do not affect how the health care providers and insurers provide the services to the citizens. In addition, development of legislation and policy has enabled the patients to have the liberty to seek care from providers that are outside the managed care network.
The Future of Managed Care
A significant number of states have had a renewed interest in implementing the managed care approach in their medical facilities. As a reimbursement model for Healing Hands Hospital, managed care promises more expansion of medical programs and more so, an increase in patient volumes. Accountable Care Organisations is a structure that includes a network of hospitals, doctors and other providers that work collaboratively to provide harmonised care to the Medicare patients (McClellan, McKethan, Lewis, Roski & Fisher, 2010). The Value Based model emphasizes on paying the providers for the value of services. As a reimbursement plan, Accountable Care Organisation and Value Based approaches require that the care providers account for the services they provide to a given population. In this case, the structure denies the organisations the liberty to give care to a significant number of patients as they are paid based on value and accountability. For this reason, the managed care program is the favorable reimbursement program for Healing Hands Hospital.
Accountable Care Organisations Models
Independent Physician Group. The approach includes a single institution that directly provides outpatient medical care.
Physician Group Alliance. The structure involves multiple organisations, which directly give outpatient care.
Expanded Physician Group. The model requires that an institution provides outpatient care, and is allowed to contract for the inpatient services (McClellan, McKethan, Lewis, Roski & Fisher, 2010).
Independent Hospital. The model required that a single organisation provides inpatient care.
Hospital Alliance. In this structure, multiple groups come together, with one providing direct inpatient care (McClellan, McKethan, Lewis, Roski & Fisher, 2010).
From the different descriptions, Healing Hands Hospital would ensure the highest level of reimbursement for the future through the Expanded Physician Group strategy. The reason for this is that the institution would be allowed to provide both inpatient and outpatient services us...