Managed Care Essay

MCO played an important element that aided the corporatization of the United Sates (U.S.) health care system (chap.3). Managed care first started to emerge in the 1900s with the flat fee payment method developed by companies who employed physical labor workers. By the 1970s to 1980s managed care grew expectantly. The HMO Act was passed by Congress in 1973. Later HMO gave birth to the dual choice mandate which was the main contributor to the rapid growth of HMOs. HMO plans were developed by BCBS and other private insurance companies. The Tax Equality and Fiscal Responsibility Act (TEFRA) enactment in 1982 helped establish the Medicare programs that used federally qualified HMOs. The state of Arizona was the first state that received

BCBS and HMOs started to a prescription drug coverage to their health plans to help attract enrollees. The rapid increase of HMO inspired the development of a new managed care plan called preferred provider organization (PPOs). Authorizations were not required to access care from any physicians. Offer discounted prices to see their preferred physicians. Precertification programs emerged and are still used today. Second-opinion program emerged but is rarely used today. Utilization management emerged from HMOs, and it contributed to the shift in medical care. Outpatient setting slowly started to become the norm. Medicare in 1982 changed its method to pay hospital visits to a fixed price per class and/or diagnoses (Peter el al, 2013).

1980 to 1990 consisted of the rapid growth and consolidation of managed care. HMO enrolled 3 million citizens in 1970, and it grew to 80 million by the end of 1999. PPO market share increased more than 10% of HMOs. Also, HMO developed the point-of-service (POS) plan that gave patients a choice to use both the HMO and POS for a added benefit of

The ACA impacts the health plan industry and access to coverage mainly. HMO coverage and health insurance cannot deny coverage based on health status preexisting conditions. All American citizens have to purchase health insurance, and if they choose not to comply, then they will receive a hefty fine. An expansion of the Medicaid program to cover more low-income U.S. citizens. The ACA developed and implemented the accountable care organization (ACO). Hospital and continuing to help increase patient flow and help increase their financial gain. Consequently, leading to higher medical cost for patients and insurance companies. The market of healthcare in the U.S is rapidly evolving and becoming more complex mostly due to the delivery of health care becoming corporatized by the help of IDSs and