week 4

What is managed care and why did it rise and fall during the 90s? According to our text, managed care is defined as an organized approach to delivering comprehensive services to its enrolled members through well-organized management of services and negation of prices with providers. Its essential feature included integration of financing, insurance, delivery and payment and formal control over utilization of services. Between the 1980s and 90’s private insurance costs increased vividly roughly about 12 percent per year. The population struggled with these rising costs. The amount of people using employer provided insurance as opposed to private insurance increased up by 86 percent in response. As the 90’s progressed and MCOs became more well-known and held more control, physicians began to become discontented. Their complaints led to tighter control on MCO’S by policy makers. What are the most common cost control methods in the managed care model of health care? Choice Restriction Gatekeeping Case Management Disease management Pharmaceutical management Utilization Review Practicing Profile What is an integrated delivery system (IDS) and the role of health IT in the IDS? An integrated delivery system is a network of organizational that provide a synchronized continuum of services to a population and is also willing to be detained as the clinical and financial responsibility outcome and health status of this specific population. Health IT serves as the role of a protuberant part of the IDS in terms of having knowledge and use of electronic medical records. These records allow providers to access across different networks and to gain information of patient history so that they can see what steps and care have been provided. This will allow providers the aptitude to make decisions that will continue to improve the health of their patients. What is an Accountable Care Organization (ACO)? An Accountable Care Organization is a integrated group of providers willing to take accountability for refining overall health status and care efficiency. ACO depend on assimilating payment and risk to improve quality and lower costs. ACO indorse teamwork between several areas across the health care gamut. Who may be an ACO and what are the suggested core competencies for ACO leaders? There are several different types of organizations that can be a ACO or a leader, this is not limited to only physicians and hospitals. Some suggested key core competencies for ACO leaders are leadership, organizational culture of teamwork, relationships with other providers, information technology infrastructure, infrastructure to monitoring, managing and reporting quality, ability to manage financial risks, ability to receive and distribute payments/savings, and resources for patient education and support. Week 4 Prediction: ACO are very beneficial to various types of organizations. ACO is solely based on improving quality, increasing patient satisfaction, and to lower costs in the health care population. According to Gruessner, “The largest benefit that accountable care could bring for the healthcare industry is to garner cost savings or reduce spending. Healthcare reforms and new federal regulations whether it is the Affordable Care Act or the HITECH Act have all brought more focus on decreasing spending throughout the medical space” (What Are the Benefits of Accountable Care Organizations?) This is extremely important because in health care the goal and priority are to put the patient first. I do believe that ACO helps place their focus towards patient care and focus on patient information which is more effectively communicated across different networks. If I was placed in a role of a hospital administer I would focus on guiding my physicians and staff to form an ACO. Also, just inform them that this would benefit population health, and improve quality. This is important for my team to understand simply because I cannot ask them to focus on ACO without them knowing the benefits that it can consist of. Of course, there will still need details and visualization of how affective it is to be lowering cost effectiveness and cost reduction of ACO. I would need to see several types of data towards this along with some research before joining/creating an ACO. On the positive side ACO is an actual alternative that I would want to consider. Reference: Gruessner, V. (2017, January 23). What Are the Benefits of Accountable Care Organizations? Retrieved November 19, 2017, from https://healthpayerintelligence.com/features/benefits-of-accountable-care-organizations