Reply prompt: Respond to the two discussion questions from classmates who reached a different conclusion than you did. Identify the points of difference in your analyses and explain how your sources and analysis led you to your conclusion. Replies must be at least 450 words each discussion reply. Each reply must reference at least 3 scholarly sources and follow current APA format (including both in-text citations and a reference list). You must also support each reply with thoughtful analysis (considering assumptions, analyzing implications, and comparing/contrasting concepts and include thorough biblical worldview integration.
Discussion Question #1
Managed health care is defined as a mechanism of providing health care services in which a single organization takes on the management of financing, insurance, delivery and payment (Shi &Singh, 2017). The first health maintenance organization (HMO) is said to have been the Western Clinic in Tacoma Washington in 1910. It offered a range of medical services to lumber mill owners and their employees for a cost of fifty cents per month (Fox & Kongstvedt, 2007). The HMO act of 1973 introduced the capitation system as opposed to the fee- for service system to help reduce the increasing cost to Medicare. The full effects of the act were not enacted until 1977 at which time the number of HMO s bean to rise. The preferred provider organization (PPO) entered the game in the late 70s and early 80s (Fox & Kongstvedt, 2007).
Explain the growth of managed care that began in the 1980s
The growth of managed health care in the 1980s was due to the out of control increases in health care. The consumer price index rose by 59% but medical care was up 117% (Shi &Singh, 2017). Most companies began to use the MCOs to help decrease the health care costs because they were affecting the profitability of the company. Medicare and Medicaid began to use MCOs to control costs but also to ensure quality of care based on patient need not the current fee for service where physicians would order unnecessary tests or procedures (Shi &Singh, 2017). During the last of the 1990s MCOs began to decline due to public opinion concerning the quality of care and the amount of control the MCOs had over the reimbursement and utilization aspects pertaining to hospitals and physicians.
How has health care delivery evolved?
The future of health care delivery will see an increase in various types of managed care options ranging from the long time HMO and PPO to the newer Accountable Care Organization (ACO) and the Patient-Centered Medical Home (PCMH). The ACO is an integrated delivery system (IDS) that includes hospitals, physicians and post discharge care. The ACO must be a legal entity and have a governing body to provide oversight (Shi &Singh, 2017). PCMHs focus on the patient beyond their medical needs. Each patient is unique and will have specific needs (Rusnuck,2017). The practice must be: physician-led, comprehensive, coordinated, accessible, and committed to quality and safety(Rusnuck,2017).
Based on the literature, what does the future hold?
As our population grows and ages we will need a solid health care system to provide the best quality care while controlling costs. As Aristotle said, The whole is greater than the sum of its parts. It will take a community effort on the part of the financing, insurance, delivery and payment groups to achieve the ultimate health care product. We can expect for MCOs to continue to shape our health care system. There will be a continuing push for quality of life for patients and incentives and accountability for health care providers.
Philippians 2:4-7 states Dont look out only for your own interests, but take an interest in others, too. You must have the same attitude that Christ Jesus had. Though he was God, he did not think of equality with God as something to cling to. Instead, he gave up his divine privileges; he took the humble position of a slave and was born as a human being. When he appeared in human form. If we can develop a strong managed heath care plan with this verse in mind we may be able to have a plan that will benefit the investors as well as the patient. (word count 609)
A quote by Aristotle. (n.d.). Retrieved August 10, 2017, from
Fox, P., & Kongstvedt, P. (2007). The Essentials of Managed Health Care (Fifth ed.). Sudbury,
MA: Jones and Bartlett.
Rusnak, W., M.D. (2017, March 22). How Patient-Centered Medical Homes Are Transforming Primary Care. Retrieved August 10, 2017, from https://www.nuemd.com/blog/patient-centered-medical-homes-transforming-primary-care.
Shi, L., & Singh, D. (2017). Essentials of the U.S. Health Care System (Fourth ed.). Burlington, MA: Jones & Bartlett Learning.
Discussion Question #2
The growth of managed care that began in the 1980s was mainly driven by Health Maintenance Organizations (HMOs). Prior to this time, doctors were still independent and payment was through fee-for-service (Zinner, 2009). If not for physicians, the U.S. health care system may have very well been one of a nationalized, universal system. It makes one ask the question whether this would have been better for America had this happened. The reason to ask is because as a by-product of fighting this a universal health care system off, inflationary health care costs rose at astronomical rates in just 10 years of 117%, while the consumer price index rose 59% during the same period (Shi & Singh, 2017, p. 220). HMOs set the stage for organized health care and reimbursement to physicians (2009). Physicians began to feel like they were losing their once dominated field, because HMOs more or less forced them to work for organizations that ultimately reduced the cost of health care, and shifted focus to a preventive health care system.
A payment system called “capitation” was put in place that paid physicians a set fee that required them to treat all their patients from this amount. This led to the term “managed care”, were not only physicians had to manage their patients within set financial limits, but made the patients (consumers) take care of themselves through “preventive medicine, consumer choice, and being accountable for one’s own health and health care” (Zinner, 2009).
Presently, approximately 95% of employees are enrolled in managed care plans, as compared to 27% in 1988 (Shi & Singh, 2017).Â One would be hard pressed to locate employees who are enrolled in an employer-sponsored conventional plan. This is probably by design since managed care is so popular, and dominates the health system’s market.
Managed care plans include many different varieties: there are HMOs, Preferred Provider Organizations (PPOs), and Point-of-Service (POS) plans. There is a chart on page 230, of our class text, that summarizes the various plans, while listing at the very top of the chart the “main distinguishing factors.” These are the type of providers, in or out of network, the method or delivery of services, and the payment an risk sharing component.
It seems the future of managed care will continue in the same direction as it is now. Hospitals, providers, private offices, and other facilities will need to continue to consolidate or integrate forces. Reimbursement payments will become tighter and stricter, and it will benefit everyone involved to work together as an integrated system to maximize profits, increase quality of care, maintain increased access to care, while keeping costs at a minimum.
There will always be those that abuse the health care system. The more efficient it becomes — the more affordable it becomes, the more frequently individuals will visit their physicians more often than they should, which will have a negative impact as this drives up prices. Until we “Come…¦return to the Lord” (Hosea 6:1a, HCSB), we will need to work on improving our health care system. “For He has torn us, and He will heal us; He has wounded us, and He will bind up our wounds” (Hosea 6:1b). What a day that will be when we will experience no more sickness!
AARP. (2017). AARP.com. Managed care plans. Retrieved on August 8, 2017 from https://advantages.aarp.org/en/healthcare-insurance/healthcare-tools-resources/understanding-health-insurance/managed-care-plans.html
Shi, L., Singh, D. (2017). Essentials of the U.S. health care system. (4th ed.) Managed care and integrated systems. (p. 220). Burlington, MA: Jones & Bartlett Learning.
Zinner, M. J., & Loughlin, K. R. (2009). The evolution of health care in america. Urologic Clinics of North America, 36(1), 1-10.doi:10.1016/j.ucl.2008.08.005