Managed Care Reform Proposal

The American College of Emergency Physicians Foundation describes managed care as “an approach to providing health care that emphasizes wellness and preventive care and seeks to reduce costs by coordinating care through a primary care physician.” Shi and Singh, the authors of Delivering Health Care in America: A Systems Approach, believe that managed care will “remain its central feature” as the US health delivery system continue to undergo changes. Managed care has been a major influence on the delivery of healthcare since 1990. It aims to deliver services that are most appropriate and cost effective while making utilization management its top priority. However, due to its tight regulation and limitations, enrollees have less access to many health care services. Additionally, the difference in quality of care between beneficiaries of managed care and traditional fee-for-service is still in question today.

Although a survey done in New York concluded that enrollees of managed care have higher satisfaction with access and use of health care services compared to those with conventional Medicaid, the extreme odds were the greatest among managed care enrollees. Thus far, studies on quality of managed care have shown little or no significant difference between those enrolled in a managed care plan and those in traditional fee-for-service. With these two matters in mind along with cost, this reform will concentrate on providing individuals with improved access to medical and health care services without increasing cost and with relevant tools, such as quality report cards, to assist individuals choose a health care plan.

Even though managed care expenditures doubled from $27 billion to $61 billion in 2002 to 2007, the spending proportion of all Medicaid spending on services is low compared to about two-thirds of Medicaid beneficiaries. This suggests that many of the highest-cost Medicaid beneficiaries and services are in the fee-for-service sector. Between 1999 and 2008, the expansion of Medicaid beneficiaries in managed care has increased respectively from 51% to 71%. With the changes of this reform, we would imagine that the number of enrollment will rise as more states “now mandate or offer managed care for more complex Medicaid populations, including children and adults with disabilities and chronic illnesses, persons with HIV/AIDS, and ‘dual eligibles’.” Strict standards and procedures have been developed to monitor and assess quality and improvement of managed care and other health care programs. According to the Henry J. Kaiser Family Foundation, nearly 30 states reported that they offer quality report cards to help Medicaid enrollees choose a health plan and quality tend to be higher in provider-owned than other Medicaid dominated plans.

This reform proposal is more important than a competing proposal because it considers three important factors: cost, access and quality. Managed care has been very cost-efficient and will continue to be as access and quality will be improved. Some people may argue that other aspects such as technology or special population may be more important due to current trends and increasing demands of that specific area.

References

"Managed Care Q&A." About Emergencies. American College of Emergency Physicians Foundation, 2011. Web. 28 Feb 2011. http://www.emergencycareforyou.org/YourHealth/AboutEmergencies/Default.aspx?id=26094

"Medicaid and Managed Care: Key Data, Trends, and Issues." (2010) Henry J. Kaiser Family Foundation. Pp. 1-8. http://www.kff.org/medicaid/upload/8046.pdf

Miller, R.H., and H.S. Luft. "DoesManaged Care Lead To Better Or Worse Quality Of Care?" Health Affairs 16.5 (1997): 7-25. Web. 28 Feb 2011. http://content.healthaffairs.org/content/16/5/7.full.pdf+html.

Shi, L., & Singh, D. A. (2008). Delivering Health Care in America: A Systems Approach (4th ed., pp. 334-371). Sudbury, MA: Jones and Bartlett Publishers.

"What is managed health care?" Managed Health Care Plans. American Heart Association, 2011. Web. 28 Feb 2011. http://www.americanheart.org/presenter.jhtml?identifier=4663