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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 set standard of guidelines and XXXXXXXXXX, I XXXXX say XXXX XXXX clients XXXX probably XXX achieve XXXX XXXXXXX. I XXXXXXX XXX XXXXXXX XXXX vary from XXXXXX to client.</span></p><p>X)</p><h5>Aspects of Medicaid managed XXXX XXXX may XXXXXX XXXXXX to and quality XX XXXX</XX> <p>Economic incentives.XXXXX XXX XXX XXXXX, the XXXXX XXXX XXXXXXXXX directly for XXXX covered service XXXXXXXX XX a XXXXXXXX XXXXXXXX. XXXXX managed care, the state pays a managed XXXX XXXX a XXXXXXXXXX XXXX&XXXXX;a fixed dollar XXXXXXXXX member XXX month—XX cover a defined XXX XX XXXXXXXX for XXXX XXXXXX enrolled in XXX XXXX. In XXXX, the XXXX XXXX providers for all XX XXX Medicaid services an enrollee XXX require that are included in XXX XXXX’s contract with the XXXXX. XXXX are XX financial XXXX if spending on services XXX XXXXXXXXXXXXXX exceeds XXXXXXXX; XXXXXXXXXX, they are XXXXXXXXX to retain any portion XX XXXXXXXX not expended XXX XXXXXXX services XXX other contractually required activities.</p> <p>XXXX suggest XXXX XXXXXXXXXX XXXX XXX provide XXXXXXXXXX XX XXXXXXXXX patients XX in XXX. XXXXXXX, managed care encourages providers to XXXX enrollees XXXXXXX in order to XXXX costs XXXXXX XXX XXXXXXXXXX rate, through XXXXXXXXXX and appropriate care XX avoid XXXXXXXXX XXXXXXXX XXXXX and emergency department XXXXXX. XXXXXXXXXX also XXXXXXXX more XXXXXXXXX when XXXXXXXXX XXX encourages the XXXXXXXXX XXX of XXXXXXXX.</p> <p>XXXXXX XXXXX that a XXXXXXXXX payment system XXXX XXXX XXXX a XXX XXXXXX per XXXXXXXX XXX XXX on how much treatment is XXXXXXXX XXX create incentives XX undertreat patients to XXXXXXXX treatment costs (<a href="http://isiarticles.com/XXXXXXX/Article/XXX/pdf/49377.XXX">Green 2014</a>;<a href="http://www.XXXX.XXX/XXXXXXX/dam/farm/XXXXXXX/reports/XXXX/rwjf401106">Sparer XXXX</a>;<a XXXX="http://XXX.XXXXXXXX.XXX/~mgduggan/Research/MD_Hayford_2013.XXX">XXXXXX XXX Hayford XXXX</a>;<a href="http://XXX.XXXX.nlm.XXX.XXX/XXX/articles/XXXXXXXXXX/XXX/11606_2010_Article_1295.pdf">Berenson XXX Rich 2010</a>). XXXXXXXXX plans XXX XXXX seek XX enroll XX many healthy XXXXXXXX XX possible and XXXXXXXXXX participation XX XXXXXXXX or XXXX XXXXXXXXX XXXXXXXXX (<a href="http://www.XXXX.XXX/papers/w19198">Kuziemko XX XX. XXXX</a>;<a href="XXXXX://XXXX.warwick.XX.uk/XXX/soc/economics/staff/jglazer/18.XXX">XXXXXX and XXXXXXX 2000</a>).</p> <p>Incentives may also be XXXXXXXXXX by capitation payment rates. For example, XXXXXXXX payments XXXXXX be able XX XXXXXXX XXXXXX XX coordinated XXX effective care while generating XXXXXXX that XXX support XXXXXXXXXX medically necessary XXXXXXXX. On XXX other hand, XX XXXXXXXXXX XXXXX are XXX too low, XXXX XXX create incentives XX restrict XXXXXXXX through use of XXXXXXXXXXX, XXXXXXXXXXXXXXXX XXXXXXXX, or limits XX benefits.</p> <p>XXX XXXXX XXX XXXX XXXXXXXX plans XX pay XXXX for XXXXXXXX, which in XXXX may reduce XXX XXXXXX XX providers willing XX XXXXX enrollees XXXX impeding their XXXXXX to XXXX. In Illinois, XXX example, XXXX of XXX traditional XXXXXX-net provider XXXXXXXXX XXXXXXXXX the XXXXX’s XXXXXXX care initiative XXXX it was implemented, arguing XXXX XXX payment rates XXXX too XXX XXX XXX bureaucratic XXXXXXXXXXXXXXX was XXX XXXX (<a XXXX="http://www.XXXX.org/XXXXXXX/XXX/farm/reports/XXXXXXX/2012/rwjf401106">Sparer 2012</a>). XXXXXXXXX have XXXX cited low XXXXXXX rates in the California Medicaid XXXXXXX care XXXXXXX XX a XXXXXXX to XXXXX XXXXXXXXXXXXX (<a XXXX="http://files.kff.XXX/XXXXXXXXXX/XXXXX-brief-XXXX-XXX-managed-XXXX-an-XXXXXXXX-and-key-XXXXXX">XXXXX et XX. XXXX</a>).</p> <p>Network composition.FFS Medicaid programs XXXXXXXXX XXXXXXXX XXXX any XXXXXXXXX provider willing XX XXXXXX XXXXXXXX XXXXXXX XXXXX, XXX Medicaid beneficiaries XXX XXXXXXX XXXXXXXX XXXXXXX XXX XXX entitled to XXXXXXX XX choice among XXXXXXXX providers. Managed care XXXXX XXX establish their own provider network qualifications, XXXXXXXX terms, XXX XXXXXXX rates (within XXXXXXXXXX required by XXX terms of XXX XXXXXXXX XXXX XXX XXXXX). XXXX generally XXXXX MCO XXXXXXXXX to a XXXXXXX of providers. MCO XXXXXXXX XXXXXXXX XXXX XX XXXXXXXXXX XX provide adequate XXXXXX to all XXXXXXX services, taking into XXXXXXX the number, XXXX, XXX geographic XXXXXXXXXXXX XX XXXXXXXXX, XXXXX other XXXXXXX, but there XXX XX XXXXXXXXX XXXXXXX to determine sufficiency.</p> <p>The XXXX and XXXXX XX the XXXXXXX XXXX affect XXX XXXXX, availability, and quality of XXXXXXXX available XX enrollees XXX access can XXXX XXXXXXXXXXXXX XXXXXX a state, XXXXXXX XXXXX and XXXXX XXXXX, and XXXXXX XXXXXX. Networks with a sufficient XXXXXX of XXXXXXXXXXXXX XXXXXXXXX XXX help ensure XXXXXX XX XXXXXXXX XXXXXXX XXXXX the contract XXXXX XXXXXX networks XXX deter specialty XXXX or XXXXX XXXXXXXXX XXX inhibit beneficiary choice and access to high XXXXXXX care. XXXXXXXX advocacy XXXXXXXXXXXXX XXXXX about XXXXXXXXXX provider XXXXXXXX and breaks in XXXX-standing patient-XXXXXXXX relationships, XXXXXXXXXX XXX XXX high-cost XXXXXXXXXXX that XXXX the most vulnerable health status (<a XXXX="XXXX://www.XXXX.XXX/XXXXXXX/dam/farm/XXXXXXX/reports/2012/rwjf401106">Sparer XXXX</a>;<a XXXX="XXXX://www.urban.XXX/XXXXX/XXXXXXX/XXXXX/publication/22601/413135-XXXXXX-Provider-XXXXXXXX-in-New-XXXXXX-Plans.XXX">XXXXXXXX et XX. XXXX</a>;<a href="http://XXX.academyhealth.XXX/publications/XXXX-XX/health-XXXX-features-implications-narrow-XXXXXXXX-and-trade-XXXXXXX-price-and">XXXXXXXXXXXXX XXXX</a>). XXXXXXXXXX variation in XXXXXXXX XXXXXX, XXXXX can XX XXXXXX by XXXX the XXXXXXX XX an MCO’s network XXX the XXXXXXXXXXXX of XXXXXXXXX in a XXXXX XXXXXXXXXX XXXX, can also XXXXXX XXX type, XXXXXXX, and XXXXXX XX services XXXX XX XXXXXXXXXXXXX (<a href="XXXX://www.gao.gov/XXXXXX/XXX/XXXXXX.pdf">GAO 2015</a>).</p> <p>XXXXXXX XXXXXXXX.Contracts XXXXXXX the XXXXX XXX XXXX identify which XXXXX XXXX services XXX XXX responsibility XX the XXX, XXXXX (if XXX) XXXXXX covered by XXX state, and which (if XXX) are XXXXXXXX XX XXXXX vendors or XXXXXXX other delivery XXXXXXX. In some XXXXX, benefits that are XXXXXX XX XXXXXXXX and have not been traditionally XXXXXXXXX through managed care, such XX long XXXX XXXXXXXX and supports or XXX-emergency transportation XXX carved out of the XXXXXXXXX XXXXXXX XXXXXXX in order XX maintain XXXXXX to XXXXX XXXXXXXX. However, XXX provision of benefits XXXXXXX XXXXXXXX delivery XXXXXXX XXX XXXXXXXXX XXX XXXXXXXXXX in XXXXXXXXXXXX XX care.</p> <p>MCOs XXXX XXXXXXX all XXXXXXXX offered under XXX XXXXX plan, but they can XXXXXXX benefits additional to FFS XXXXX the so-XXXXXX in lieu of policy. Under this policy, MCOs contracts XXX XXXXX, XXX enrollees, cost-effective services XXXX are in addition XX those XXXXXXX XXXXX XXX XXXXX plan, although XXX cost XX XXXXX services cannot XX XXXXXXXX when determining XXX payment rates (42 CFR 438.6(c)). XXXXXXX MCOs XXX provide services in addition XX those XXXXXXX under XXX XXXXX plan, XXXXXX XX XXXX XXX XX XXXXXXXX XXX XXXXX enrollees. XXXXX XXXXXXXX are often XXXXXXXX services XXXX may XXXXXXXXXX to XXXX XX XXXXXXXXX care such as, XXXX XXXXXXXXXX or XXXXXXXXXXXXXX services XXX XXXXXXX under XXX state XXXX, long-term XXXXXXXX and XXXXXXXX, or social XXXXXXXXXXXXX XXXX as XXXXXXXXX, XXXXXXXXX, or XXXXXXXX XXXXXXXX with XXXXXXXXXXXX XXXX other XXXXXXXXXXXXX.</p> <p>Contracting XXXXXXXXXXXXXX XXX oversight. Medicaid XXXXXXX XXXX XXXXX XXX XXXXXXXX to XXXX access and quality standards that do not apply XX other Medicaid XXXXXXXX systems. XX described in XXXXXXX XXXXXX in the following section, XXXXX are XXXXXXX statutory and regulatory XXXXXXXXXXXX, such XX standards for XXXXXX XXX XXXXXXXX and a requirement for periodic XXXXXXXX XXXXXXX review, XXXX XXXX XXXXX to MCOs. Further, states may impose additional XXXXXX XXX quality XXXXXXXXXXXX on XXXXXXXX XXXX through the procurement and contracting XXXXXXX. XXXXXX can require XXXXX XX XXXX certain standards (e.g., XXXXXXXXXXXXX) in order to XXXXXXXXXXX, provide payment or XXXXXXXXXX XXXXXXX XXX the XXXXXXXXXXX XX XXXXXXX quality or XXXXXX XXXXX, XXX require XXXX XX participate in quality improvement XXXXXXXXXX.</p><p>.<XX></p><p>X)</p><p>ETHICAL<XX>CONSIDERATIONS<br>* X sincere XXXXXX to XXXXXXXX the XXXXXXXXX of XXX<XX>provider XXXXXXX relationship. XXXX relationship XX XXX-<XX>XXXXXXXX in XXXXXX XXX XX XXXXX XX XXXXXXXXXXXXXXX, XXXXX,<br>XXX honesty.<br>* The XXXXXXXXX XX XXXXXXXXXXX a balance XX prudent<br>spending XXXXXXX XXXXXXX XXXXXXXXX XXXXXXX as opposed<br>to XXX XXXXX of XXX greater XXXXXXXXX. XX XXX XXXX sug-<br>XXXXXX that a XXXXXXXXXXXX conference XX XXXXXXX XXXXXXX<XX>goals XXX XXXXXXXX limitations would be XXXXXXXXX in<XX>many cases for orthopedic surgeons.<XX>* XX XX likely XXXX managed XXXX and particularly XXXX-<XX>XXXXXX will generate XXXXXXXX XXXX-XX-case ethical<br>XXXXXXXX for orthopedists.<XX>* Incentives XXXXXXXX the orthopedic XXXXXXXX as well.<XX>XXX limitation of XXXXXXXXXX work-up XXX XXXXXXXXXX<XX>management XXXXX XXXX XXXX XX a XXXXXXXXXXX XXXXXXXX</p><p>with XXXXXX XX treatment protocol. X XXXX in point is XXX<XX>XXXXXXXXXX XXXXXX XX physical XXXXXXX XXX XXXXXXXXXXXXXX<XX>in the XXXXXXXXXXXXX XXXXXXX. XXXXXXX XXX XX XXXXX XX<br>be XXXXX in these XXXXXXXXXX, but cost XXXXXXXXXXXXXX pre-<br>vail. XXXXX also can XX a XXXXXXXXXXXX for the XXXXXXXXXX<br>XXXXXXX in certain managed care XXXXX XX XXXXX a XXXXXXX<XX>for XXXXXXXXXXXX evaluation or care. XX is therefore<br>XXXXXXXXX that the managed XXXX XXXX XX written in such<XX>a XXX XX XX ensure that XXXXXXXX XXXXXXXXXXXXXX are XXX<br>XXX predominant factor in referral XXXXXXXXX.<br>* When the agreement or contract XXXXXXX the XXXXXXX<br>and the managed XXXX XXXXXXXXXXXX prohibits XXX ortho-<br>pedic XXXXXXX XXXX XXXXXXXXX the XXXXX and XXXXXXXXX<br>treatnent XXXXXXXX, the orthopedist has an XXXXXXXXXX XX<XX>inform the patient XX what XXXX XXX will XXX XX XXXXXXX<XX>XX XXX plan and XX sucggest XXXXX alternatives for care. It<XX>XXXX may be XXXXXXXXX to XXXX a protest through XXX<br>plan's XXXXXX process.<br>* XX XXXXXXXXXX XXXXXXXXX, there XXX be an XXXXXX XX<br>covered XXXXX that XXXXXXX a dilemmafor orthopedic sur-<br>geons. A similar XXXXXXX XX XXXX XX inappropriate or<br>excessive referrals from primary XXXX physicians. This,<br>of course, is XXX opposite of XXXX occurs in XXX HMO<XX>(gatekeeper) XXXXX in which the orthopedist XXXXXXXX<XX>care XXX discounted XXX for XXXXXXX.<br>* Stark XX XXXXXXXXXXX, ofJanuary 1, 1995, bans Medicare<br>XXX the XXXXXXX XXXXXXXX XXXXXXXXXX payments XXX certain<XX>"XXXXXXXXXX health services" XXXXXXXX to XXXXXXXX XXX<XX>are referred XXX these XXXXXXXX by a XXXXXXXXX who has<XX>XXXXXXXXX XXXXXXXX or XXXXX XXXXXXXXXXXX arrangements<XX>XXXX providers XX XXXXX XXXXXXXX. Services XXXX XX XXXX-<br>nostic XXXXXXXXX, XXXXXXXX therapy, durable medical equip-<XX>ment, orthotics, occupational XXXXXXX, and prosthetic<br>devices XXXXXXXX impact XX the XXXXXXXXXX practice.<XX>XXXXX XXXXXXX dilemmas in XXXXXXX care XXX XXXXX-<XX>pedic surgeons XXXXXXX XXX following:<XX>* joint venture XXXXXX perceived monopoly XX a group<br>or XXXXXXXXXXXX,<br>* false XXXXXXXXXXXXX that may XXXXXXX the public, XXX<br>* XXXXXXX XX XXX XXXXXXXXX and XXXXXXX information XXXX<XX>nonbusiness partners.</p>">
