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Managed Care Organizations Case Study

1075 Words5 Pages

The evolution of managed care organizations has created a dramatic change in our health care system. In 1995, about 161 million American citizens, were enrolled into a managed care organization plan. Some of the plans under the managed care are health maintenance organizations (HMO), preferred provider organizations (PPO), point of service plans (POS), and other networks such as Exclusive Provider Organization (EPO), and union plans. All these plans are different from one another in regards to organization structure, reimbursement for providers, types of services, and care access strategies. However, the goals established by managed care are to reduce and control cost of medical and behavioral health services through case management or care …show more content…

Once the private and public sector agencies provide these members to a managed care organization, and their responsibility is to be responsive to the care of their member and the health care system. For these managed care organization to fulfill this they need to be accredited, licensed, certified, credentialed, meet guidelines, report card based on services, performance measures. However, all these requirements for a managed care to create a model of care but I believe the behavioral/mental health services are still not meeting …show more content…

The public sector is funded and financed by the state and government for Medicare and Medicaid coverage and broad range of different medical services and treatments. As for the private sector it shares different structures but collaborates and often corresponds with public sector amenities. Some of the private sector examples are employee assistance programs in the workplace, and managed behavioral health and they are starting to associate with public organizations to help patients.

Other federal supported systems like the U.S Department of Defense (Tricare) and U.S Department of Veterans Affairs (VA) share both private and public sector care systems but different care service systems. Also, care services are also different for children, Native Americans, and seniors. As a result, of having a higher number of self-governing delivery organizations aiding other populations under different fund aids it causes difficulty assessing to improve quality of

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