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Managed Care


Question : Provide a thorough analysis of managed care, and discuss how it, as a delivery method, has facilitated the transfer of health services to outpatient and other nontraditional settings of care. Discuss the impact managed care has on the access, financing, and delivery of health care in the United States. Discuss managed care’s role in promoting health.



Today, with advent of new technologies, it is found that the healthcare organizations are looking for new ways and options to provide state-of-the-art healthcare services to the patients. Even, it is noticed that patients have turn more aware in such cases and hence are expecting better quality healthcare services in a given environment (Park, 2015). The term managed care refers to a set of activities that are deployed with an objective to not only provide best quality healthcare services in a given non-traditional healthcare setting but will also aim to reduce the cost of providing such healthcare services to the people. Some of the ways through which these options are delivered to the patients include health insurance plans, flexible spending account, health reimbursement accounts, State Children's Health Insurance program, and others (Park, 2015).


After the implementation of the Affordable Care Act of 2010, the government is aiming to introduce new mechanism through which they will be able to reduce the overall healthcare costs for the people in a given environment (Park, 2015). This report will thereby discuss on managed care, the implementation approach, the ways through which it is delivered to the people, its impact on various aspects, and finally its approach to promote healthcare across the nation.

Managed Care: An Overview

Managed care is a type of healthcare delivery system that is organized and implemented with an objective to manage costs, quality, and overall utilization. This option is aimed to provide people with a variety of healthcare services at reduced costs and with better access (Hu, Chou, &amp; Deily, 2015).

In addition, there will be contracted arrangements carried out between the managed care organizations and state Medicaid agencies that will accept a particular payment per month from the people for using these services. The government will thereby be able to reduce the respective Medicaid program costs and instead will provide with better services that these people can utilized as per their different needs (Hu, Chou, Deily, 2015).


Managed care plans are also referred to as health insurance plans that will allow the healthcare providers to care for the members at reduced costs. The providers will be setting up a network that later will allow the users to choose the best plan for them as per their requirements. Thus, the major benefits of managed care plans include - comprehensive benefits, evidence- based quality care practices, well-documented services, accountability, and integrated delivery systems (Hu, Chou, ; Deily, 2015).

However, there are certain concerns regarding this issue that include - delays in receiving care, lack of understanding the bills, and certain charges based upon coverage. Thus, there is a need to improve on these issues and thereby continue to serve the given community in the US.

Importance of Delivery Method in facilitating the Transfer of health services to outpatients and other nontraditional settings of Care

The importance of delivery methods in managed care is important since the outpatients will not be able to attend the hospitals or any other healthcare  organizations. Thus, they need to first have an access to the different managed care plans in a given environment.

Once they subscribe for such plans they will be connected directed with a network wherein there will be several entities. These include - doctors, nursing staff, other specialists, ancillary care services, laboratory personnel, and even support staff to provide desired services to these patients (Mas, 2013). However, there are different ways through which a given customer will have an access to such insurance plans in a given environment.


The patients can choose from - health maintenance plan, independent practice association, preferred provider organization, point of service, or even private fee for service plans. It will thereby allow them to have the desired access of services and thereby get the necessary healthcare treatment in a given environment. However, it will be the responsibility of both the entities and the healthcare staff to look after the patients in such cases.

Impact of Managed Care on Access, Financing, and Delivery of healthcare services in US

The impact of managed care on access, financing, and delivery of healthcare services in the US will be huge as it not only ensures providing the best services to the patients but also ensures that the entire network of different healthcare community performs as per the expectations (Mas, 2013). In a given network, there are several people connected with each other and hence it is their responsibility to perform their roles accordingly in a given working environment.

Once the patient logs in the complaint, the care team immediately needs to respond them with the first-stage level services. There will be healthcare professionals and nursing staff that will be immediately resuming to the location of the patient. If the initial stage analysis ensures that the patient will be benefited from medications then there will be no further services deployed (Mas, 2013); however, if the patient is required to get admitted in the hospital, the next stage of services will be started for the purpose of implementation.

The role of the healthcare organization and the hospital staff will now be playing an important role in delivering the required healthcare services. There will be also ambulatory care services provided to the patients in some of the extreme cases. It is important to note that the impact of care delivery methods will thereby impact on the access, finance, and delivery aspects for the patients in a better way.

Managed Care's role in Promoting Health

The role of managed care services is to provide healthcare services to the patients at reduced costs and with increased access to different healthcare services in a given environment. The role of the healthcare staff will be thereby important as they need to deliver required healthcare services as per the expectations of the patients (Ehlert &amp; Oberschachtsiek, 2014).

They need to focus more on extended care services for the outpatients so that they can save on their - time, efforts, costs, and even access. In some of the extreme services, it is the responsibility of the healthcare organizations to make medical arrangements for the patients and ensure effective treatment in critical conditions (Ehlert &amp; Oberschachtsiek, 2014). On the other hand, the role of the government will be to monitor these services, identify the gaps, if any, and provide recommendations for future outcomes.


This report discusses about the role of managed care services in a given environment. The healthcare organizations and the government are putting efforts to reduce the overall costs of healthcare in a given environment (Lewis &amp; Pflum, 2015). The patients however need to provide feedbacks and reviews so that they can improve this system further. Also, the government and other regulatory agencies can share their reviews to improve the entire managed care system for the future.


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