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Managed Care Changes

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Why Change is Difficult in the Healthcare Environment A major change is occurring in the healthcare system as the United States continues to move toward enhancing patient care quality and access while also decreasing cost. This significant transformation is driven by a variety of forces, including changes in managed care, a shift from pay for service to pay for quality, and ever-evolving client characteristics. This paper aims to discuss each of these factors and the ways in which they make this major transformation a difficult one for the nation to undergo. Changes in Managed Care In the article “Understanding Managed Care Plans”, Michael Bihari (2016) explains that “all managed care plans contract with doctors, hospitals, clinics, and other …show more content…

1). With the continued transformation of the healthcare system, an increased emphasis on consumerism and quality-based reimbursement will be observed. This could lead to challenges for all managed care stakeholders. One example of an industry change that might occur is that patients’ out-of-pocket costs could increase. The cost of healthcare continues to rise faster than inflation, generating increased incentives for insurance companies to offer plans with high deductibles and small networks. In the article “The Top Changes MCOs Should Expect in 2016” Joel Brill (2015) states that: According to a PwC’s 2014 Touchstone Survey, 44% of employers across all industries were considering limiting their offerings to high-deductible plans within the next three years. A 2015 Robert Wood Johnson report showed that 41% of provider networks available through silver plans on the Affordable Care Act marketplace are “small” or “extra small” (p. …show more content…

It is also essential that these people are aware of the necessity of screenings and other preventative care, and that they build on their general healthcare knowledge and literacy. Comprehension of these factors allows consumers to make well-informed decisions and select the option that is best for their circumstances. Accessible, user-friendly tools such as websites and mobile apps can assist consumers with these tasks. The service-based pay structure provides significant motivation for healthcare providers to deliver as many services as possible, with little to no consideration of patient outcomes. Furthermore, this structure provides no incentive for certain key elements of healthcare such as patient education and care coordination, both of which have led to diminished costs and better outcomes for patients. I am of the opinion that very little quality improvement will take place if this pay-for-service model persists. The current transition from service-based pay to quality-based pay is definitely a move in the right

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