Analyzing Managed Care Models

ANALYZING MANAGED CARE MODELS 1

AnalyzingManaged Care Models

Typesof Managed Care Models

Integrated Delivery System (IDS)

Integrated Delivery System is a health care organizations’ network, which is under a holding parent company. The term is broadly used to refer to an organization, which aims at providing continued health care services. For this model, the insurance plan is the Humana

Exclusive Provider Organization (EPO)

An exclusive provider organization refers to a hybrid health insurance plan whereby does not necessarily involve a primary care provider. Here, EPO demands that payment scheme be paid in what is referred to as a fee for service (Garber, 2000). What is not provided is the out of network care, and pre-authorization requires visits. The insurance plan is the Kaiser Permanente

Preferred Provider Organization (PPO)

Here, preferred provider organization agrees with the insurer in question or a third party administrator. This is when heath care requires provision to the client at reduced rates. The insurance plan is the CIGNA

Health Maintenance Organization (HMO)

This is a model which arranges or provides managed care for the health insurer, benefits plans. Unlike other indemnities, HMO covers health care, which is rendered to the medical practitioners (Garber, 2000). An insurance plan for this model is the Magnacare

Points of Sale (POS)

POS refers to a point where services are exchanged between the client and the service provider. This point may involve money in exchange of services. Here, the insurance plan is the Wellpoint

Triple Option Plan (TOP)

TOP permits the insurer to give health care plans, which will allow the patient to pick from varied options whenever he or she needs it. TOP is costly, but it allows the patient to have a number of choices among the hospitals and physicians to choose from. TOP’s insurance plan is the Health Net.

Managed care isknown to have an impact on the physicians’ practices. First, theimpact involves the relationship between the physicians and theirpatients. Managed care could determine how the physicians’practices influence on the relationships, how they begin and end. Themodel may also restrict access of preferred providers with thephysicians (Garber, 2000). Additionally, managed care controls accessof patients to services offered by the physicians, and as a result,curtail the patients’ freedom prompting reduction of thephysicians’ efforts to render quality services.

The impact of costreduction and other factors such as cost sharing and access tomanaged care have resulted in improved health care and cost savingsamong the patients. These factors have ensured there is considerablehassle upon the physicians, which have in turn represent regulationof health care for fear of minimal realization of profits to theservices rendered (Garber, 2000). All this have also impacted on thePhysicians practices on how the regulations would fuel the anxietyfrom the patients over structures that are of managed care.

References

Garber, S. (2000). Managed care and the evaluation and adoption ofemerging medical technologies. Santa Monica, CA: RAND.