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managed care discussion 200 words
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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 XXX XXXXXXXX XX XXXXXXXXXX XXX XXXXXXXXXX, I would XXX that most clients XXXX probably XXX achieve XXXX XXXXXXX. I XXXXXXX the XXXXXXX will XXXX from XXXXXX XX XXXXXX.</span></p><p>2)</p><XX>Aspects of Medicaid XXXXXXX care XXXX may affect access to XXX quality XX XXXX</h5> <p>Economic incentives.XXXXX XXX FFS model, the XXXXX XXXX providers XXXXXXXX XXX XXXX XXXXXXX service received by a XXXXXXXX XXXXXXXX. Under managed XXXX, the XXXXX XXXX a managed care plan a XXXXXXXXXX rate—a fixed dollar XXXXXXXXX member per XXXXX&XXXXX;to XXXXX a defined XXX XX XXXXXXXX XXX XXXX XXXXXX XXXXXXXX in the plan. XX turn, XXX plan pays XXXXXXXXX XXX all of XXX Medicaid services an enrollee XXX require that are included in the plan’s contract with the XXXXX. MCOs are at XXXXXXXXX risk XX XXXXXXXX on services and XXXXXXXXXXXXXX exceeds XXXXXXXX; conversely, XXXX XXX XXXXXXXXX XX XXXXXX any XXXXXXX XX XXXXXXXX not expended XXX covered services and XXXXX contractually required XXXXXXXXXX.</p> <p>XXXX XXXXXXX that XXXXXXXXXX does not XXXXXXX incentives XX overtreat XXXXXXXX XX in XXX. Instead, XXXXXXX XXXX encourages XXXXXXXXX XX keep XXXXXXXXX healthy in order XX XXXX costs XXXXXX XXX XXXXXXXXXX rate, XXXXXXX preventive XXX appropriate XXXX XX XXXXX XXXXXXXXX XXXXXXXX XXXXX and emergency XXXXXXXXXX XXXXXX. XXXXXXXXXX XXXX provides more XXXXXXXXX when budgeting and encourages XXX XXXXXXXXX use of services.</p> <p>Others argue that a XXXXXXXXX XXXXXXX system XXXX XXXX XXXX a set amount XXX XXXXXXXX XXX XXX XX how much XXXXXXXXX XX XXXXXXXX XXX XXXXXX XXXXXXXXXX XX XXXXXXXXXX XXXXXXXX XX XXXXXXXX XXXXXXXXX XXXXX (<a href="XXXX://XXXXXXXXXXX.com/bundles/Article/pre/pdf/49377.pdf">Green XXXX</a>;<a href="http://www.XXXX.XXX/content/XXX/XXXX/XXXXXXX/XXXXXXX/2012/XXXXXXXXXX">XXXXXX XXXX</a>;<a XXXX="XXXX://XXX.XXXXXXXX.edu/~mgduggan/XXXXXXXX/XXXXXXXXXXXXXXX.XXX">Duggan and Hayford 2013</a>;<a href="http://XXX.ncbi.XXX.nih.XXX/pmc/XXXXXXXX/XXXXXXXXXX/pdf/XXXXXXXXXXXXXXXXXXXXXXX.pdf">Berenson and Rich XXXX</a>). Capitated XXXXX XXX also XXXX to enroll XX XXXX XXXXXXX XXXXXXXX as XXXXXXXX and discourage participation XX XXXXXXXX or high XXXXXXXXX enrollees (<a XXXX="http://www.XXXX.XXX/XXXXXX/w19198">Kuziemko XX al. 2015</a>;<a XXXX="https://www2.warwick.XX.XX/fac/soc/XXXXXXXXX/staff/XXXXXXX/XX.XXX">XXXXXX XXX XXXXXXX 2000</a>).</p> <p>Incentives XXX also be influenced by XXXXXXXXXX payment rates. For example, XXXXXXXX XXXXXXXX should XX able XX XXXXXXX XXXXXX XX coordinated and effective care XXXXX generating savings that can support additional XXXXXXXXX XXXXXXXXX XXXXXXXX. XX the XXXXX XXXX, if XXXXXXXXXX XXXXX are set too low, XXXX XXX create XXXXXXXXXX to XXXXXXXX XXXXXXXX through use XX XXXXXXXXXXX, XXXXXXXXXXXXXXXX policies, or XXXXXX on XXXXXXXX.</p> <p>XXX XXXXX may XXXX XXXXXXXX plans to XXX XXXX XXX services, which in turn may reduce XXX number XX XXXXXXXXX willing to XXXXX enrollees XXXX impeding XXXXX access XX care. In Illinois, for XXXXXXX, XXXX XX XXX traditional XXXXXX-net provider community XXXXXXXXX XXX state’s managed care initiative when it XXX XXXXXXXXXXX, arguing XXXX the XXXXXXX XXXXX were XXX XXX XXX XXX bureaucratic micromanagement was XXX high (<a XXXX="XXXX://XXX.rwjf.org/content/dam/XXXX/reports/XXXXXXX/2012/rwjf401106">Sparer XXXX</a>). Providers have also cited XXX payment rates in the California XXXXXXXX managed care XXXXXXX XX a XXXXXXX to XXXXX XXXXXXXXXXXXX (<a XXXX="http://files.kff.XXX/attachment/issue-brief-medi-XXX-XXXXXXX-XXXX-an-XXXXXXXX-and-XXX-issues">Tater XX XX. XXXX</a>).</p> <p>XXXXXXX composition.XXX Medicaid XXXXXXXX typically XXXXXXXX with any XXXXXXXXX provider XXXXXXX to accept Medicaid XXXXXXX XXXXX, and Medicaid XXXXXXXXXXXXX who XXXXXXX XXXXXXXX through FFS XXX XXXXXXXX to freedom XX choice XXXXX XXXXXXXX providers. XXXXXXX care XXXXX XXX XXXXXXXXX XXXXX own XXXXXXXX XXXXXXX qualifications, XXXXXXXX terms, and XXXXXXX rates (within XXXXXXXXXX required by XXX XXXXX XX XXX XXXXXXXX with the state). They generally XXXXX MCO enrollees XX a XXXXXXX of providers. MCO XXXXXXXX networks must XX XXXXXXXXXX to provide adequate XXXXXX XX XXX covered services, XXXXXX XXXX XXXXXXX XXX XXXXXX, XXXX, XXX XXXXXXXXXX XXXXXXXXXXXX of providers, among XXXXX factors, but there XXX no universal XXXXXXX to determine sufficiency.</p> <p>The size and XXXXX XX XXX network XXXX XXXXXX XXX XXXXX, availability, XXX quality XX XXXXXXXX XXXXXXXXX to enrollees XXX access XXX vary XXXXXXXXXXXXX XXXXXX a XXXXX, XXXXXXX XXXXX XXX XXXXX XXXXX, and XXXXXX states. Networks with a sufficient XXXXXX XX XXXXXXXXXXXXX XXXXXXXXX may help ensure XXXXXX XX XXXXXXXX covered under the XXXXXXXX while narrow networks may XXXXX XXXXXXXXX care or other referrals and XXXXXXX XXXXXXXXXXX XXXXXX XXX access XX high XXXXXXX care. XXXXXXXX XXXXXXXX organizations XXXXX XXXXX XXXXXXXXXX provider networks XXX XXXXXX in XXXX-XXXXXXXX XXXXXXX-XXXXXXXX XXXXXXXXXXXXX, XXXXXXXXXX XXX the XXXX-cost XXXXXXXXXXX XXXX have XXX most vulnerable XXXXXX status (<a href="XXXX://www.rwjf.org/XXXXXXX/XXX/XXXX/reports/reports/XXXX/rwjf401106">XXXXXX 2012</a>;<a XXXX="XXXX://XXX.XXXXX.org/sites/XXXXXXX/XXXXX/publication/XXXXX/413135-Narrow-Provider-Networks-in-New-Health-Plans.PDF">XXXXXXXX XX al. 2014</a>;<a href="XXXX://www.XXXXXXXXXXXXX.org/publications/2015-XX/XXXXXX-XXXX-XXXXXXXX-implications-XXXXXX-XXXXXXXX-and-trade-XXXXXXX-price-XXX">XXXXXXXXXXXXX XXXX</a>). XXXXXXXXXX XXXXXXXXX in provider XXXXXX, XXXXX XXX be XXXXXX XX XXXX XXX XXXXXXX XX an MCO’s network and the availability of providers in a XXXXX geographic area, can also affect the type, quality, and XXXXXX of XXXXXXXX XXXX by XXXXXXXXXXXXX (<a XXXX="http://XXX.XXX.XXX/assets/680/670548.XXX">GAO XXXX</a>).</p> <p>Covered XXXXXXXX.Contracts XXXXXXX the state and XXXX identify XXXXX state plan services are the XXXXXXXXXXXXXX of the XXX, XXXXX (XX XXX) remain XXXXXXX by XXX XXXXX, and XXXXX (if any) XXX provided XX other XXXXXXX or XXXXXXX other delivery systems. In some cases, XXXXXXXX that XXX unique to XXXXXXXX and XXXX not been XXXXXXXXXXXXX XXXXXXXXX XXXXXXX managed XXXX, such XX XXXX XXXX XXXXXXXX and supports or non-XXXXXXXXX transportation are XXXXXX out XX the XXXXXXXXX benefit package in order XX XXXXXXXX XXXXXX to these services. XXXXXXX, XXX XXXXXXXXX of benefits through XXXXXXXX XXXXXXXX XXXXXXX XXX introduce XXX XXXXXXXXXX in XXXXXXXXXXXX XX XXXX.</p> <p>XXXX XXXX provide all benefits offered XXXXX XXX XXXXX plan, XXX they XXX provide benefits additional to XXX XXXXX XXX so-called in XXXX XX policy. XXXXX this policy, MCOs XXXXXXXXX may XXXXX, for XXXXXXXXX, XXXX-effective XXXXXXXX that XXX in XXXXXXXX to those XXXXXXX XXXXX XXX XXXXX XXXX, XXXXXXXX the cost XX these services cannot XX included when XXXXXXXXXXX XXX payment XXXXX (XX CFR XXX.6(c)). Because MCOs can XXXXXXX XXXXXXXX in addition to XXXXX XXXXXXX XXXXX the state XXXX, access to XXXX XXX XX enhanced XXX their XXXXXXXXX. These services are XXXXX enabling services that XXX XXXXXXXXXX to XXXX of XXXXXXXXX XXXX such XX, case XXXXXXXXXX or transportation services not XXXXXXX under the state plan, long-term services XXX XXXXXXXX, or XXXXXX XXXXXXXXXXXXX XXXX XX XXXXXXXXX, XXXXXXXXX, or XXXXXXXX XXXXXXXX XXXX XXXXXXXXXXXX with XXXXX XXXXXXXXXXXXX.</p> <p>Contracting specifications and XXXXXXXXX. Medicaid managed XXXX XXXXX XXX XXXXXXXX to meet access and XXXXXXX XXXXXXXXX XXXX XX XXX XXXXX XX XXXXX XXXXXXXX XXXXXXXX XXXXXXX. XX XXXXXXXXX in XXXXXXX XXXXXX in XXX following XXXXXXX, there are XXXXXXX statutory XXX XXXXXXXXXX requirements, XXXX XX standards for access XXX XXXXXXXX and a XXXXXXXXXXX XXX periodic XXXXXXXX quality XXXXXX, that XXXX apply to MCOs. Further, states may XXXXXX XXXXXXXXXX access and quality requirements XX Medicaid XXXX XXXXXXX XXX XXXXXXXXXXX XXX contracting process. States XXX XXXXXXX plans XX meet certain XXXXXXXXX (e.g., accreditation) in order XX participate, XXXXXXX XXXXXXX or XXXXXXXXXX bonuses XXX XXX achievement of XXXXXXX quality or access goals, and require MCOs XX XXXXXXXXXXX in XXXXXXX improvement activities.</p><p>.<XX></p><p>X)</p><p>ETHICAL<XX>CONSIDERATIONS<br>* X XXXXXXX effort to maintain the integrity XX XXX<br>XXXXXXXX XXXXXXX XXXXXXXXXXXX. XXXX XXXXXXXXXXXX is con-<br>tractual in XXXXXX XXX is XXXXX XX confidentiality, XXXXX,<XX>and XXXXXXX.<XX>* The XXXXXXXXX of maintaining a balance of XXXXXXX<br>spending XXXXXXX patient XXXXXXXXX desires as opposed<br>to the needs of the XXXXXXX community. XX XXX XXXX sug-<XX>gested that a pretreatment XXXXXXXXXX to XXXXXXX XXXXXXX<XX>goals XXX XXXXXXXX XXXXXXXXXXX XXXXX be XXXXXXXXX in<br>XXXX cases for XXXXXXXXXX XXXXXXXX.<br>* It XX likely that XXXXXXX care XXX particularly XXXX-<XX>XXXXXX will generate frequent XXXX-XX-case XXXXXXX<XX>dilemmas XXX orthopedists.<br>* XXXXXXXXXX XXXXXXXX the orthopedic XXXXXXXX XX XXXX.<XX>XXX limitation of XXXXXXXXXX work-XX and definitive<br>management XXXXX XXXX lead to a XXXXXXXXXXX XXXXXXXX</p><p>with regard XX treatment XXXXXXXX. X XXXX in XXXXX is the<XX>XXXXXXXXXX placed on physical therapy and rehabilitation<br>in XXX postoperative XXXXXXX. XXXXXXX XXX be shown to<br>be XXXXX in XXXXX situations, XXX XXXX considerations XXX-<XX>vail. There also XXX be a disincentive XXX the XXXXXXXXXX<XX>XXXXXXX in certain XXXXXXX care plans XX refer a patient<br>XXX subspecialty XXXXXXXXXX or XXXX. XX XX therefore<br>important XXXX the XXXXXXX care plan XX XXXXXXX in XXXX<br>a XXX as to ensure that XXXXXXXX XXXXXXXXXXXXXX are XXX<br>XXX predominant XXXXXX in XXXXXXXX decisions.<br>* XXXX the XXXXXXXXX or XXXXXXXX XXXXXXX XXX XXXXXXX<br>XXX the XXXXXXX XXXX organization XXXXXXXXX the XXXXX-<br>XXXXX surgeon XXXX providing XXX usual and XXXXXXXXX<br>XXXXXXXXX expected, the XXXXXXXXXXX has an XXXXXXXXXX XX<br>XXXXXX the XXXXXXX XX what will XXX will XXX XX XXXXXXX<XX>XX the plan and to XXXXXXXX other XXXXXXXXXXXX XXX care. XX<br>also XXX be necessary to file a XXXXXXX through the<br>XXXX's appeal XXXXXXX.<br>* In capitation contracts, there may XX an XXXXXX of<XX>XXXXXXX XXXXX XXXX present a dilemmafor XXXXXXXXXX XXX-<br>geons. X XXXXXXX XXXXXXX is XXXX XX XXXXXXXXXXXXX or<XX>XXXXXXXXX XXXXXXXXX from XXXXXXX XXXX physicians. This,<br>of course, is XXX XXXXXXXX of XXXX XXXXXX in the XXX<br>(XXXXXXXXXX) model in XXXXX the orthopedist XXXXXXXX<XX>care XXX discounted XXX for XXXXXXX.<br>* Stark 11 legislation, ofJanuary X, XXXX, bans XXXXXXXX<XX>XXX XXX XXXXXXX portioni ofMedicaid payments for XXXXXXX<br>"XXXXXXXXXX health services" XXXXXXXX XX patients XXX<XX>are XXXXXXXX XXX XXXXX XXXXXXXX by a physician XXX XXX<br>ownership interest or other XXXXXXXXXXXX arrangements<XX>with XXXXXXXXX XX these XXXXXXXX. Services XXXX as XXXX-<XX>XXXXXX XXXXXXXXX, XXXXXXXX therapy, durable XXXXXXX XXXXX-<XX>XXXX, XXXXXXXXX, XXXXXXXXXXXX therapy, XXX XXXXXXXXXX<XX>devices XXXXXXXX XXXXXX XX the XXXXXXXXXX XXXXXXXX.<XX>Other XXXXXXX dilemmas in managed XXXX XXX XXXXX-<br>pedic XXXXXXXX XXXXXXX the following:<XX>* joint venture XXXXXX XXXXXXXXX monopoly XX a group<XX>or XXXXXXXXXXXX,<br>* XXXXX XXXXXXXXXXXXX that XXX mislead XXX XXXXXX, and<br>* XXXXXXX XX XXX schedules XXX billing information XXXX<br>nonbusiness partners.</p>">
