Medicaid Managed Care: A Case Study

From these chapter I have gain the knowledge of know, the delivery of health traditionally evolved around the individual relationship between the provider and patient/consumer. The payment was either provided by a health insurance company or paid out of pocket by the consumer. This fee-for-service system or indemnity plan increased the cost of healthcare because there were no controls on how much to charge for the providers service. As healthcare costs continued to spiral out of control throughout the decades, more experiments with contract practice and prepaid service occurred randomly across the U.S. healthcare system (Shi & Singh, 2008)
As well knowing, the National Committee on Quality Assurance (NCQA) was established to maintain the quality of care in health plans. NCQA was established in 1990 to monitor health plans and improve healthcare quality. Their focus is to measure, analyze, and improve healthcare programs. The NCQA has developed a report card of accredited health plans that consumers can access on their website. There are currently 41 states that recognize the NCQA accreditation for both their Medicaid managed care and commercial managed care programs. Additionally, the NCQA has a physician directory that recognizes quality practices.
The managed care model for healthcare delivery was developed for the primary purpose of containing healthcare costs.
Observing from my classmates I have learned from them that there are six types of managed care models. There are the health maintenance organizations (HMOs), the preferred provider organizations (PPOs), exclusive provider organizations (EPOs), physician hospital organizations (PHOs), point-of-service (POS) plans, and provider-sponsored organizations