Trends in Managed Care - 94054

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Trends in Managed Care

Internationally, the development of health care policy continues to be influenced more by cost considerations. Advancement in health science and its delivery has increased the capabilities of treatment. A major subject of debate has been the ability of nations and communities to pay for this care. Significant trends have taken course in managed health care are intricate and complex. Half of all enrollees of Medicaid receive care through risk-based managed care organizations i.e. MCOs most of which are low are low-income children and families. In almost 20 states, at least some of the beneficiaries are dually meet the eligibility for Medicare and Medicaid.

Provider networks, care delivery, and payment arrangements in Medicaid MCOs today

Medicaid MCOs’ provider networks and care management features are designed in a manner that ensures that they meet the needs of their current enrollees which happen to be mainly low- income children and families. Community health centers plus other safety-net providers play an integral role in in ensuring to most of the health plan’s and networks. System gaps that relates to access to care are exacerbated in Medicaid and pressures that exist are likely to grow as states expand Medicaid managed care to beneficiaries that are more complex. MCOs are shifting focus to care management and models to ensure more comprehensive coordination and integration of services. Physician payment approaches in MCOs are diverse ranging from fee-for service to capitation, often with incentives for quality and efficiency.

MCO provider networks have since evolved to meet needs of special people including those with disabilities and dual eligible which constitutes mental and behavioral health care, acute medical care and community-based services and supports. Coordination and integration have made challenging by the existence of separate data systems and funding streams.  Individuals with disabilities want engagement in directing their own medical care and need to be represented at the table when management initiatives are being developed. The desirability of bundled payment systems, that provide incentives for effective and efficient care, has to be balanced against the loss of transaction-level data needed for measurement,

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