Managed Care Organizations and Integrated Health Care Networks
Topic 5 DQ 1
“Managed Care is a health care delivery system organized to manage cost, utilization, and quality. Medicaid managed care provides for the delivery of Medicaid health benefits and additional services through contracted arrangements between state Medicaid agencies and managed care organizations (MCOs) that accept a set per member per month (capitation) payment for these services.” (Medicaid, n.d) This system is to help insure that all challenges are taken care of, so that a patient can receive the care they need. In the video “Do We Know What Know What Our Future Holds?” It explains that it all starts with the primary care and the patients experience. In the patients time at the hospital the main focus is the primary care and interventions for the patient, but the experience for this patient is just as important. by having these various MCOs, the Medicaid program is getting more efficient with their level of health care while reducing the cost.
Times have changed, which means the health care is changing as well. We need to find ways to provide care to the people that either cannot afford it or that are not insured. “Many uninsured people avoid seeking medical care unless they are faced with an emergency or delay care until their symptoms become intolerable.” (NILC, 2017) This has been an issue health care workers have been trying to deal with for years but has never improved. When these people get into the hospital it will sometimes be to late and there is no level of care that can help them get better. To save people from this there has to be a plan in place to get these people moving in the right direction. “The extent to which health care cost growth has outpaced wage growth is staggering. From 2000 to 2019, health spending in the US increased 87 percent while median household income increased by only 10 percent. Today, average annual health insurance premiums for a family of four are $21,342.” (Cooper, 2021)
There is also a problem with the younger generations getting started on their own. Costs of life is growing exceedingly high and we are seeing kids that don’t have anything to grow on and have to pay for their own health insurance. “Under the law, if a plan includes children, a parent can cover children on their health insurance plan until the child turns 26 years old.” (CMS, n.d.) Most people at this age are still trying to figure out a career and I think their should be a plan in place for this. If you are unable to provide yourself with your own insurance then you should be able to stay on your parents until you can get your own. This will help cut down on the uninsured and help people with the cost.
Health care organizations continually face challenges from various regulatory and government agencies while also being bound by Managed Care Organization (MCO) standards. View the video located in the study materials entitled “College of Nursing and Health Care Professions: Do We Know What Our Future Is?” for insight into the challenges of health care reform. Based on the video, describe two key reform factors that you believe will need to be addressed by future health care workers or leaders and explain why. (Note: You can download slides from this video for ease of review in developing your forum response). Additionally, what role does adherence to MCO standards play in your future health care vision?
Using 200-300 words APA format with at least two references. Sources must be published within the last 5 years. There should be a mix between research and your reflections. Add critical thinking in the posts along with research. Apply the material in a substantial way.