Toggle navigation
Ask Questions
Ask
Answer Questions
Answer
Users
FAQ
Login
Register
Preview 50% of the Answer Below
Due to formatting, images, tables, or paragraphs may be out of place or not shown. Rest assured that they will be included and formatted correctly in your purchased answer.
Details
Question Title:
managed care discussion 200 words
Go Back to the Question
Answer Preview
1) Managed care involves tools and processes that manage resources and delivery of human services in</span><span class="t s1_6 f8" <the="" medical="" and="" mental="" health="" field="" (woodside="" &="" mcclam,="" 2012,="" ch.="" 3).="" managed="" care="" has="" affected="" <="" span="">>span class="t s1_6 f8"<the delivery="" of="" human="" services="" exponentially.="" clients="" receive="" the="" lowest="" amount="" and="" care="" <="" span="">>span class="t s1_6 f8"<that can="" be="" financially="" covered="" or="" reimbursed,="" but="" that="" meet="" the="" client's="" needs.="" this="" facet="" of="" managed="" <="" span="">>span class="t s1_6 f8">care is recognized as external review (Woodside & McClam, 2012, Ch. 3). Addressing specific client </that></the></span><span class="t s1_6 f8">populations is also a complicated matter with managed care. Those dealing with specific difficulties </span><span class="t s1_6 f8">and issues such as juvenile delinquency, illiteracy, and unemployment are also facing individual prob-</span><span class="t s1_6 f8">lems that are complex and specific to their environment, upbringing, and needs that have been unmet.</span><span class="t s1_6 f8" <therefore,="" developing="" a="" "system"="" of="" managed="" care="" for="" these="" groups="" and="" individuals="" becomes="" more="" <="" span="">>span class="t s1_6 f8">general and broad, not specific. </span><span class="t s1_6 f8">It is hard for me to say that client care has improved because of managed care. I obviously have not </span><span class="t s1_6 f8">had much experience in dealing with managed care in the human service industry.However just from readingabout the process, I would say it has its advantages and disadvantages. Providing the lowest amount of care that is still beneficial to the client saves time, money, and resources. But when dealing with specific populations where you are having to follow a set standard of XXXXXXXXXX XXX XXXXXXXXXX, I XXXXX say that XXXX XXXXXXX XXXX XXXXXXXX XXX XXXXXXX much success. I XXXXXXX the outcome XXXX vary XXXX client XX client.</span></p><p>X)</p><XX>XXXXXXX XX Medicaid XXXXXXX care XXXX may XXXXXX access to XXX quality of XXXX</XX> <p>Economic XXXXXXXXXX.Under XXX XXX XXXXX, the state pays XXXXXXXXX XXXXXXXX XXX XXXX XXXXXXX service XXXXXXXX by a XXXXXXXX XXXXXXXX. XXXXX managed XXXX, XXX XXXXX pays a managed XXXX plan a capitation rate&XXXXX;a fixed XXXXXX XXXXXXXXX XXXXXX per month&XXXXX;to cover a defined set of services XXX XXXX person enrolled in the plan. In turn, XXX XXXX XXXX XXXXXXXXX for all XX XXX XXXXXXXX XXXXXXXX an enrollee may require XXXX XXX included in the plan’s contract XXXX the XXXXX. MCOs XXX at financial risk XX spending on XXXXXXXX XXX administration XXXXXXX XXXXXXXX; conversely, XXXX XXX XXXXXXXXX XX XXXXXX any portion of XXXXXXXX not expended XXX covered services XXX XXXXX XXXXXXXXXXXXX required XXXXXXXXXX.</p> <p>XXXX XXXXXXX XXXX capitation XXXX XXX provide XXXXXXXXXX to overtreat XXXXXXXX as in XXX. XXXXXXX, XXXXXXX XXXX encourages providers XX XXXX enrollees XXXXXXX in order XX keep costs within the XXXXXXXXXX XXXX, XXXXXXX preventive XXX XXXXXXXXXXX care XX XXXXX XXXXXXXXX XXXXXXXX stays and XXXXXXXXX department XXXXXX. XXXXXXXXXX also provides XXXX certainty XXXX XXXXXXXXX and encourages XXX XXXXXXXXX use XX XXXXXXXX.</p> <p>XXXXXX argue XXXX a XXXXXXXXX payment system XXXX pays XXXX a XXX amount XXX XXXXXXXX and not on how much XXXXXXXXX XX XXXXXXXX may XXXXXX incentives XX undertreat XXXXXXXX to XXXXXXXX XXXXXXXXX XXXXX (<a href="http://isiarticles.com/bundles/XXXXXXX/XXX/XXX/XXXXX.XXX">XXXXX XXXX</a>;<a XXXX="http://XXX.XXXX.XXX/content/XXX/farm/XXXXXXX/reports/2012/XXXXXXXXXX">Sparer XXXX</a>;<a XXXX="XXXX://XXX.XXXXXXXX.edu/~XXXXXXXX/Research/XXXXXXXXXXXXXXX.pdf">XXXXXX and Hayford XXXX</a>;<a href="XXXX://XXX.ncbi.XXX.XXX.gov/XXX/articles/XXXXXXXXXX/XXX/11606_2010_Article_1295.XXX">Berenson and XXXX XXXX</a>). Capitated plans may also XXXX to XXXXXX as many healthy XXXXXXXX XX possible and XXXXXXXXXX participation XX disabled or high XXXXXXXXX XXXXXXXXX (<a href="http://XXX.XXXX.org/papers/w19198">XXXXXXXX et al. 2015</a>;<a XXXX="https://XXXX.warwick.ac.uk/fac/soc/XXXXXXXXX/staff/XXXXXXX/XX.pdf">Glazer XXX XXXXXXX 2000</a>).</p> <p>XXXXXXXXXX XXX XXXX be XXXXXXXXXX by XXXXXXXXXX XXXXXXX XXXXX. XXX example, XXXXXXXX XXXXXXXX XXXXXX be able to provide XXXXXX to coordinated XXX effective care XXXXX XXXXXXXXXX XXXXXXX XXXX can support XXXXXXXXXX medically necessary XXXXXXXX. On the XXXXX XXXX, if XXXXXXXXXX XXXXX XXX set too low, XXXX may create incentives to restrict services through XXX XX XXXXXXXXXXX, XXXXXXXXXXXXXXXX XXXXXXXX, or limits on XXXXXXXX.</p> <p>Low XXXXX may also motivate plans to XXX XXXX for XXXXXXXX, XXXXX in turn may reduce XXX XXXXXX of XXXXXXXXX willing XX treat XXXXXXXXX thus impeding their XXXXXX XX XXXX. XX XXXXXXXX, for XXXXXXX, XXXX XX XXX traditional XXXXXX-net XXXXXXXX XXXXXXXXX boycotted the state’s XXXXXXX XXXX XXXXXXXXXX XXXX it XXX XXXXXXXXXXX, arguing that the payment XXXXX were too XXX and XXX XXXXXXXXXXXX XXXXXXXXXXXXXXX XXX too high (<a href="XXXX://XXX.rwjf.org/content/dam/XXXX/reports/XXXXXXX/XXXX/rwjf401106">Sparer 2012</a>). XXXXXXXXX XXXX also cited low payment XXXXX in XXX XXXXXXXXXX Medicaid XXXXXXX care XXXXXXX XX a barrier to their XXXXXXXXXXXXX (<a href="http://XXXXX.XXX.org/XXXXXXXXXX/issue-XXXXX-medi-XXX-managed-XXXX-an-XXXXXXXX-XXX-key-XXXXXX">XXXXX et XX. 2016</a>).</p> <p>Network composition.FFS Medicaid XXXXXXXX typically XXXXXXXX XXXX XXX XXXXXXXXX XXXXXXXX XXXXXXX to XXXXXX Medicaid XXXXXXX rates, XXX Medicaid beneficiaries XXX receive XXXXXXXX XXXXXXX FFS XXX XXXXXXXX XX freedom XX choice among Medicaid providers. Managed care plans XXX establish their own XXXXXXXX network qualifications, contract XXXXX, and payment rates (within XXXXXXXXXX required XX the XXXXX of XXX XXXXXXXX with XXX XXXXX). They XXXXXXXXX limit XXX XXXXXXXXX to a XXXXXXX XX providers. MCO XXXXXXXX networks XXXX XX sufficient to XXXXXXX adequate XXXXXX XX XXX XXXXXXX XXXXXXXX, taking into account XXX number, type, XXX geographic distribution XX providers, XXXXX other XXXXXXX, but there are no universal metrics to determine sufficiency.</p> <p>XXX XXXX XXX scope XX XXX network XXXX affect the types, availability, and quality XX XXXXXXXX XXXXXXXXX XX XXXXXXXXX XXX access XXX XXXX substantially XXXXXX a state, XXXXXXX XXXXX and XXXXX areas, XXX XXXXXX XXXXXX. Networks with a XXXXXXXXXX XXXXXX of XXXXXXXXXXXXX providers XXX XXXX ensure XXXXXX XX services covered under the XXXXXXXX while narrow XXXXXXXX XXX deter specialty care or other XXXXXXXXX and inhibit beneficiary choice XXX XXXXXX to high quality XXXX. XXXXXXXX advocacy organizations XXXXX about XXXXXXXXXX provider networks and XXXXXX in long-XXXXXXXX XXXXXXX-provider XXXXXXXXXXXXX, XXXXXXXXXX XXX XXX high-cost populations that XXXX XXX most vulnerable XXXXXX XXXXXX (<a XXXX="http://XXX.XXXX.org/content/dam/farm/XXXXXXX/reports/2012/XXXXXXXXXX">Sparer XXXX</a>;<a XXXX="http://www.urban.org/XXXXX/default/files/XXXXXXXXXXX/XXXXX/XXXXXX-Narrow-Provider-Networks-in-XXX-Health-XXXXX.XXX">Corlette et al. 2014</a>;<a XXXX="http://XXX.XXXXXXXXXXXXX.org/XXXXXXXXXXXX/2015-XX/health-plan-XXXXXXXX-implications-narrow-networks-and-trade-between-price-and">XXXXXXXXXXXXX XXXX</a>). Geographic variation in XXXXXXXX access, which can be XXXXXX by both the XXXXXXX XX an MCO’s XXXXXXX XXX XXX XXXXXXXXXXXX of XXXXXXXXX in a given geographic XXXX, can XXXX XXXXXX XXX type, XXXXXXX, and amount XX services XXXX by XXXXXXXXXXXXX (<a href="XXXX://XXX.gao.gov/XXXXXX/XXX/XXXXXX.pdf">XXX 2015</a>).</p> <p>XXXXXXX benefits.Contracts XXXXXXX XXX XXXXX and MCOs XXXXXXXX which state plan XXXXXXXX are the responsibility XX the XXX, which (XX XXX) XXXXXX XXXXXXX by the state, and which (if any) XXX XXXXXXXX by other vendors or XXXXXXX XXXXX delivery systems. In XXXX XXXXX, XXXXXXXX that XXX XXXXXX XX XXXXXXXX XXX have not XXXX traditionally delivered XXXXXXX managed XXXX, such XX XXXX term XXXXXXXX XXX XXXXXXXX or non-XXXXXXXXX XXXXXXXXXXXXXX are XXXXXX out of XXX XXXXXXXXX benefit package in order XX XXXXXXXX XXXXXX XX these XXXXXXXX. XXXXXXX, the XXXXXXXXX of benefits through XXXXXXXX delivery systems XXX XXXXXXXXX new challenges in XXXXXXXXXXXX of XXXX.</p> <p>MCOs XXXX provide all XXXXXXXX offered XXXXX the XXXXX XXXX, XXX they XXX XXXXXXX XXXXXXXX XXXXXXXXXX to XXX using XXX so-called in XXXX of policy. Under XXXX policy, MCOs contracts may cover, XXX XXXXXXXXX, XXXX-XXXXXXXXX services that are in XXXXXXXX XX those covered under XXX XXXXX XXXX, although the cost XX these XXXXXXXX cannot be included XXXX XXXXXXXXXXX XXX payment rates (42 XXX XXX.6(c)). Because XXXX can XXXXXXX XXXXXXXX in XXXXXXXX XX XXXXX XXXXXXX XXXXX XXX state plan, XXXXXX XX XXXX XXX be enhanced for XXXXX XXXXXXXXX. XXXXX services XXX often XXXXXXXX services that XXX XXXXXXXXXX XX XXXX of obtaining care such as, case management or XXXXXXXXXXXXXX XXXXXXXX XXX covered XXXXX the state plan, XXXX-XXXX XXXXXXXX XXX XXXXXXXX, or social interventions such XX XXXXXXXXX, XXXXXXXXX, or XXXXXXXX provided with partnerships with XXXXX organizations.</p> <p>Contracting XXXXXXXXXXXXXX XXX XXXXXXXXX. Medicaid managed XXXX XXXXX are XXXXXXXX to XXXX access and XXXXXXX XXXXXXXXX that do not apply to other Medicaid XXXXXXXX systems. XX XXXXXXXXX in XXXXXXX detail in the XXXXXXXXX section, there are XXXXXXX statutory and regulatory XXXXXXXXXXXX, XXXX XX XXXXXXXXX for XXXXXX and capacity XXX a XXXXXXXXXXX for XXXXXXXX external XXXXXXX XXXXXX, XXXX XXXX apply XX MCOs. Further, XXXXXX XXX XXXXXX additional XXXXXX and XXXXXXX requirements on Medicaid MCOs XXXXXXX XXX XXXXXXXXXXX and XXXXXXXXXXX process. XXXXXX XXX XXXXXXX plans XX XXXX XXXXXXX XXXXXXXXX (e.g., accreditation) in order XX XXXXXXXXXXX, provide XXXXXXX or enrollment bonuses for XXX XXXXXXXXXXX of XXXXXXX quality or XXXXXX goals, XXX XXXXXXX MCOs to XXXXXXXXXXX in quality XXXXXXXXXXX XXXXXXXXXX.</p><p>.<br></p><p>3)</p><p>ETHICAL<br>XXXXXXXXXXXXXX<br>* A XXXXXXX XXXXXX to XXXXXXXX the XXXXXXXXX XX XXX<br>provider XXXXXXX relationship. This relationship XX XXX-<br>XXXXXXXX in nature and is XXXXX XX XXXXXXXXXXXXXXX, trust,<XX>and honesty.<br>* XXX challenge of maintaining a XXXXXXX XX prudent<XX>XXXXXXXX between patient XXXXXXXXX desires as opposed<XX>to XXX needs XX the greater community. XX has been XXX-<XX>XXXXXX that a XXXXXXXXXXXX XXXXXXXXXX XX XXXXXXX XXXXXXX<XX>goals and economic XXXXXXXXXXX would XX advisable in<XX>many XXXXX XXX orthopedic surgeons.<br>* XX is XXXXXX that managed XXXX XXX XXXXXXXXXXXX capi-<br>XXXXXX XXXX XXXXXXXX XXXXXXXX XXXX-XX-case XXXXXXX<br>XXXXXXXX XXX XXXXXXXXXXXX.<br>* Incentives confront the orthopedic practice as well.<br>The limitation of diagnostic work-XX and XXXXXXXXXX<XX>management XXXXX will XXXX to a compromised XXXXXXXX</p><p>with XXXXXX to XXXXXXXXX XXXXXXXX. A XXXX in point XX XXX<br>limitation XXXXXX XX XXXXXXXX therapy and rehabilitation<br>in the postoperative patient. XXXXXXX XXX XX shown to<br>be XXXXX in XXXXX XXXXXXXXXX, but XXXX XXXXXXXXXXXXXX pre-<br>XXXX. XXXXX also can XX a disincentive for the XXXXXXXXXX<br>XXXXXXX in XXXXXXX managed XXXX plans XX XXXXX a XXXXXXX<XX>for XXXXXXXXXXXX evaluation or care. XX is therefore<XX>important that the XXXXXXX care XXXX be written in XXXX<br>a XXX XX XX XXXXXX that XXXXXXXX XXXXXXXXXXXXXX are XXX<XX>the predominant factor in referral decisions.<XX>* When the XXXXXXXXX or XXXXXXXX between the XXXXXXX<XX>XXX XXX managed XXXX XXXXXXXXXXXX prohibits XXX ortho-<XX>pedic surgeon from providing XXX XXXXX and XXXXXXXXX<XX>treatnent expected, the orthopedist has an XXXXXXXXXX to<br>inform the XXXXXXX of XXXX XXXX and XXXX not be XXXXXXX<XX>XX XXX plan XXX XX sucggest XXXXX alternatives XXX XXXX. It<br>XXXX XXX XX XXXXXXXXX XX XXXX a protest XXXXXXX the<XX>plan's appeal process.<br>* In capitation contracts, XXXXX XXX be an XXXXXX of<XX>XXXXXXX lives that present a dilemmafor XXXXXXXXXX XXX-<br>geons. X XXXXXXX XXXXXXX is XXXX XX XXXXXXXXXXXXX or<XX>XXXXXXXXX XXXXXXXXX XXXX XXXXXXX XXXX XXXXXXXXXX. XXXX,<br>of XXXXXX, XX the XXXXXXXX of XXXX XXXXXX in XXX HMO<XX>(XXXXXXXXXX) model in which XXX XXXXXXXXXXX provides<XX>care XXX discounted fee XXX XXXXXXX.<br>* Stark 11 legislation, ofJanuary 1, XXXX, XXXX XXXXXXXX<br>XXX the XXXXXXX XXXXXXXX ofMedicaid payments for XXXXXXX<br>"XXXXXXXXXX XXXXXX XXXXXXXX" XXXXXXXX XX XXXXXXXX XXX<XX>are XXXXXXXX for these XXXXXXXX XX a physician XXX has<XX>ownership interest or XXXXX compensation XXXXXXXXXXXX<br>XXXX XXXXXXXXX XX these services. Services such XX XXXX-<XX>nostic radiology, XXXXXXXX XXXXXXX, XXXXXXX XXXXXXX XXXXX-<br>ment, XXXXXXXXX, XXXXXXXXXXXX XXXXXXX, and XXXXXXXXXX<XX>devices directly XXXXXX XX the orthopedic practice.<br>Other ethical XXXXXXXX in XXXXXXX care for XXXXX-<XX>XXXXX surgeons include the XXXXXXXXX:<br>* XXXXX XXXXXXX versus perceived XXXXXXXX XX a group<XX>or conglomerate,<XX>* false advertisement that may XXXXXXX XXX XXXXXX, XXX<br>* sharing of XXX schedules XXX XXXXXXX information with<br>nonbusiness XXXXXXXX.</p>">
