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Unit 4 Discussion Topic 2

Darnella

Managed care plans negotiate reduced payments for services and can contract with specific hospitals and providers as one way to control costs (Frakt, 2011). Care coordination is a core component of managed care, especially with people that have complex chronic conditions and disabilities (Bowers, Owen, & Heller, 2017). According to Medicaid.gov (n.d.), managed care helps manage cost, utilization, and quality. Coordinating care and making sure there is no unnecessary tests or treatments helps eliminate wasteful spending. According to Bowers et al. (2017), the quality of care coordination is associated with better health outcomes. A benefit of managed care could be the management and prevention of polypharmacy according to Stefanacci (2017).

According to Sekhri (2000), overemphasis on cost containment can threaten the quality of medical care. Focusing on lowering costs and not focusing on quality healthcare could cause poor outcomes. Denials for needed diagnostic testing or waiting for approvals could potentially delay medical treatment for a patient. The managed care coordinator must be able to review and respond to special requests from primary care providers in a timely manner and not place cost over true medical need to prevent a diminish in quality of care. Coordination of care between primary and specialty physicians can eliminate redundancy. According to Blumenthal, Chernof, Fulmer, Lumpkin, and Selberg (2016), we need to develop a deep understanding of the high-need, high-cost patient population and identify evidence-based programs that can offer high quality and integrated care at a lower cost. With managed care, this can be accomplished through the coordination care.

References

Blumenthal, D., Chernof, B., Fulmer, T., Lumpkin, J., and Selberg, J. (2016). Caring for high-need, high-cost patients — An urgent priority. The New England Journal of Medicine, 375(10), 909-911. doi:10.1056/NEJMp1608511

Bowers, A., Owen, R., & Heller, T. (2017). Care coordination experiences of people with disabilities enrolled in Medicaid managed care. Disability and Rehabilitation, 39(21), 2207-2214. doi:10.1080/09638288.2016.1219773

Frakt, A. B. (2011). How much do hospitals cost shift? A review of the evidence. The Milbank Quarterly, 89(1), 90-130. doi:10.1111/j.1468-0009.2011.00621.x

Medicaid.gov. (n.d.). Medicaid managed care. Retrieved January 24, 2018, from https://www.medicaid.gov/medicaid/managed-care/ind…

Sekhri, N. K. (2000). Managed care: the U.S. experience. Bulletin of the World Health Organization, 78(6), 830-844. Retrieved from http://www.who.int/bulletin/archives/78(6)830.pdf

Stefanacci, R. G. (2017). Can managed care manage polypharmacy? Clinics in Geriatric Medicine, 33(2), 241-255. doi:10.1016/j.cger.2017.01.005

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