Preview

Compare And Contrast The Managed Care Delivery Model

Satisfactory Essays
Open Document
Open Document
173 Words
Grammar
Grammar
Plagiarism
Plagiarism
Writing
Writing
Score
Score
Compare And Contrast The Managed Care Delivery Model
There are many reasons why the managed care delivery model was created mostly to reduce cost and to remove unnecessary testing and treatment. I am going to Describe two different types of managed care, and the differences between the two.
HMO (Health Maintenance Organization) also known as (Managed Care Organizations) contract with a group of providers, or a panel of health care providers.
HMO’s focus on preventive healthcare, the key purpose is to lower health care costs, delivering services according to specific stipulations. in which delivery of medical services examined to determine whether the services are necessary to review the Payment.
PPOs (Preferred Provider Organization) represent another type of managed care. Within this organization,
Continue Reading
View Writing Issues

You May Also Find These Documents Helpful

  • Good Essays

    Hcr 230 Week 1 Assignment
    • 473 Words
    • 2 Pages

    Hcr 230 Week 1 Assignment

    With HMO plans there is a list of providers that the patient can only go to, if they go to a doctor that is not in the list of providers they will have to pay extra. The only way that a patient should see a provider out of the network is if it is an emergency. HMO’s have an annual premium and a copayment that is due at the time of service. The main services the HMO’s cover is preventive and wellness checks and disease management. However, in order for complete coverage the enrollees must see a doctor that offers an HMO plan. The providers manage the care and referrals are required, low payments, ad this plan does cover preventative care.…

    • 473 Words
    • 2 Pages
    Good Essays
    Read More
  • Better Essays

    Hcs 440 Week 3 Economic Issues Simulation
    • 1187 Words
    • 5 Pages

    Hcs 440 Week 3 Economic Issues Simulation

    The purpose of a managed care organization is to coordinate the costs and delivery of health care. A managed care organization oversees money spent on labor, technology, and facilities such as physician offices and hospitals. A type of managed care organization is a Health Maintenance Organization (HMO). A HMO “provides medical care for all its enrollees in return for a fixed annual fee per enrollee” (University of Phoenix, 2010, Key Terms and Concepts Section). An HMO tightly oversees the use of health care services thereby reducing costs and controlling utilization. For example, HMO’s…

    • 1187 Words
    • 5 Pages
    Better Essays
    Read More
  • Better Essays

    HCS 235 Week 2 Completed Health insurance matrix
    • 1163 Words
    • 4 Pages

    HCS 235 Week 2 Completed Health insurance matrix

    HMO’s were first introduced in the 1940’s. In the time that has passed they have since evolved. This came with help from the Health Maintence Act of 1973. HMO’s are a form of prepaid health plan. This means that you receive services that are being paid for in advance either by you or your employer.…

    • 1163 Words
    • 4 Pages
    Better Essays
    Read More
  • Satisfactory Essays

    Hcr 220 Features of Health Plans
    • 373 Words
    • 1 Page

    Hcr 220 Features of Health Plans

    Health Maintenance Organizations or HMOs only allow people to see providers that are within the HMO system. The primary care physician has to make all referrals and manages all the care. There are no payments for out of plan non-emergency services but some care requires pre-authorizations. This plan features low copayments, there is a limited provider organization and pre-caution care is covered with this plan.…

    • 373 Words
    • 1 Page
    Satisfactory Essays
    Read More
  • Satisfactory Essays

    You Decide Project Paper
    • 593 Words
    • 3 Pages

    You Decide Project Paper

    reduced as well in comparison to a regular PPO health plan. The main disadvantage for HMO…

    • 593 Words
    • 3 Pages
    Satisfactory Essays
    Read More
  • Good Essays

    Hypertension and Castor Standard Castor
    • 627 Words
    • 5 Pages

    Hypertension and Castor Standard Castor

    This simulation looks at providing health care insurance coverage from the standpoint of a health maintenance organization (HMO). As HMO executives, your obligation is to provide health care for the members you insure. You must do this with a high degree of quality at a price that covers services rendered. To do this, you must offer only those services you may provide at the cost the customer can pay.…

    • 627 Words
    • 5 Pages
    Good Essays
    Read More
  • Satisfactory Essays

    Managed Care Delivery Model Analysis
    • 394 Words
    • 2 Pages

    Managed Care Delivery Model Analysis

    The managed care delivery model was intended to decrease unneeded health care costs, by controlling the level of service along with the type of service that was being provided. This model came in a response to the rocket costs of the unrestricted fee-for-service plans in the 1980s. (PBS.org) Managed care plans are a type of health insurance.…

    • 394 Words
    • 2 Pages
    Satisfactory Essays
    Read More
  • Satisfactory Essays

    Compare And Contrast Hmo Vs Hmos
    • 206 Words
    • 1 Page

    Compare And Contrast Hmo Vs Hmos

    A difference is, ACOs are more truly integrated compared to HMOs. The ACOs integration is accomplished through organizational structure and through sharing of electronic records, neither of which were common with early HMOs. There is now more information about how to manage care than there was in the early days of HMOs. ACOs can take advantage of health care guidelines, quality metrics and knowledge about patient costs. Finally, there is an increased emphasis on measurable outcomes, which will help ACOs reach performance goals and benchmark their performance. ACOs like HMOs do not rely on full capitation. Instead, they usually put providers at risk for a portion of the cost of care; that risk is shared with insurers, somewhat sidestepping a…

    • 206 Words
    • 1 Page
    Satisfactory Essays
    Read More
  • Good Essays

    Managed Care Pros and Cons
    • 394 Words
    • 2 Pages

    Managed Care Pros and Cons

    The pros of managed care are since the patient is limited to a specific caregiver the premium is lower. The patient only pays a monthly payment and a co-payment. The cons of managed care are that the patients are not allowed to see the doctor of their choice unless the doctor is in their network. The consumers perspective the pros and cons of managed care. The pros from the consumers perspective would be only paying monthly payments that is at a fixed rate. The other would be paying a small co-payment every time they see a doctor. The cons of managed care from a consumers perspective would be that they cannot see the doctor of their choice. The caregiver has to be affiliated with the managed care organization. The pros and cons from a caregivers perspective. The pros would be stability, fewer administrative duties, and better working hours. The cons would be less independence, and possibly a decrease in the income. There are more pros and cons these are just a few of them. From a caregivers perspective they would rather the patient have traditional insurance. The reason for this is because the caregiver is losing money by the patient having managed care. Caregivers get a percentage of the money when they see a patient with traditional insurance. Then there is also more stability and less working hours for the caregiver with managed care. It would be like flipping a coin for the caregiver what would they rather have more money or more time to spend with their family. The consumers perspective it would be in their best interest to have one of the managed care options (HMO,PPO). The reason for this answer is because for the most part most consumers…

    • 394 Words
    • 2 Pages
    Good Essays
    Read More
  • Satisfactory Essays

    Medicaid Managed Care: A Case Study
    • 290 Words
    • 2 Pages

    Medicaid Managed Care: A Case Study

    The managed care model for healthcare delivery was developed for the primary purpose of containing healthcare costs.…

    • 290 Words
    • 2 Pages
    Satisfactory Essays
    Read More
  • Good Essays

    Managed Care Case Study
    • 792 Words
    • 4 Pages

    Managed Care Case Study

    For the past several years, the health care and insurance industries in America have been undergoing significant reform in order to rein in the high cost of delivering health care services. Managed care has become a cornerstone of this process (Strickland, 1995). The case management industry (with its focus on cost containment, managed competition, and quality care) is playing an increasingly important role in the managed care environment (Owens, 1996). According to Mullahy (1995a), the number of case managers has risen astronomically in recent years. These individuals come from diverse professional backgrounds and practice settings that include nursing, rehabilitation counseling, and social work.…

    • 792 Words
    • 4 Pages
    Good Essays
    Read More
  • Good Essays

    Similarities and Differences Between Managed Cares
    • 686 Words
    • 3 Pages

    Similarities and Differences Between Managed Cares

    Managed care has been formed since the 1930 and evolved over the last ten years. Since the evolving of managed care there are three types of managed care plans. People that are enrolled in private health insurance are subscribed to a type of managed care plan. There are many differences between the three types of managed care plans and they also have similarities. The involvement of managed care plans are between the insurer and the selected network of health care providers, and the policyholder’s financial incentive that are used by the providers in the network. There are precise measures for choosing a managed care plan and conventional procedures to acquire quality care (Types of Insurance, 2010).…

    • 686 Words
    • 3 Pages
    Good Essays
    Read More
  • Better Essays

    Evolution of Managed Care
    • 1519 Words
    • 7 Pages

    Evolution of Managed Care

    Managed care is a type of system that was formed to help control the costs and quality to health care services; this will give access to services to specific groups of covered patients. The system was created to help the patients (customers) to receive services without having the full financial burden (University of Washington, 1998). The managed care services’ goal is to be able to help individuals and their families by providing health care services that is affordable. This type of managed care will help employees or individuals by requiring a set fee to be paid to the physician for visits, a co-pay and monthly premium to be paid to the insurance company. This will lower the amount that the patient has to pay. There have been many demands that have been needed in the managed care system; changes have had to be made to keep improving the health care services to help it to continue to grow. This paper will cover how the managed care began, in addition to how the system has grown and the changes of the system.…

    • 1519 Words
    • 7 Pages
    Better Essays
    Read More
  • Good Essays

    Similarities Between Healthcare And Medicare
    • 882 Words
    • 4 Pages

    Similarities Between Healthcare And Medicare

    The difference between the two includes the size of the network, ability to see specialist, plan cost, and coverage for out-of- network services. (“PPO VS HMO: What is the difference?). The HMO is more affordable and allows you to choose a doctor or the insurance assigns a doctor that is in your network at a cost dictated by the insurance. This usually lowers or eliminates the deductibles. However, the PPO plan is more flexible and consumers get to choose the doctor and the hospital even if it is not in network at a rate above what the insurance will pay. The patient is usually responsible for out of network cost and…

    • 882 Words
    • 4 Pages
    Good Essays
    Read More
  • Good Essays

    Health Care Systems Compare and Contrast
    • 793 Words
    • 4 Pages

    Health Care Systems Compare and Contrast

    As a country we are facing currently facing a problem based on health care. Every country has their own way of doing things, but which way makes the most sense? Statistics show that Canada’s health care system is working for them, but will it work for the United States? Ezekial J. Emanuel, Holly Dressel, and together, Karen Davis, Cathy Shoen, Katharine Shea, and Kristine Haran, all address possible solutions to this problem. While Emanuel feels that America’s system is sufficient, Dressel, Davis, Shoen, Shea, and Haran believe there are better options. These authors evaluate the different systems based on quality, cost, and accessibility.…

    • 793 Words
    • 4 Pages
    Good Essays
    Read More

Related Topics