post by CHR
Healthcare costs have risen to the point individuals are looking at the cost not the condition before going to see a doctor. In order to help alleviate the cost many healthcare providers and facilities are looking at managed care. Managed care looks to limit the healthcare spending by coordinating care across provider networks and promoting cost-effective care. Studies have shown that managed care can result in cost savings for the individuals. When comparing Medicare Advantage (a managed care plan) against conventional Medicare, it was found the Medicare Advantage individuals had reduced healthcare expenses (Boudreau et al., 2022). This is able to be done because of negotiated provider fees, using only medically necessary services and to focus on preventative care to help reduce costs in the future. By using managed care networks duplicate testing and procedures are reduced. Some are concerned that by cutting the costs through managed care plans the patients are not getting the best quality healthcare. According to Stephenson (2022), patients covered by conventional Medicare were more likely than Medicare Advantage (managed care) patients to be provided additional care at an inpatient rehabilitation facility or at home. There are also concerns the managed care organizations will have too much power when it comes to telling patients where they can receive treatment. Patients will have limited decision making when it comes to their own healthcare.
Like any other change there will be people to resist. The providers may not want to participate in the manage care networks due to lower reimbursement rates. By limiting the patients to certain participating providers, patient satisfaction may go down. It could also limit patient access to the providers by distance or because of physicians not able to accommodate all the patients involved in the manage care network. Managed care may lower the healthcare costs but there are concerns about the quality of care and availability of healthcare providers. Finding a mutually satisfactory balance between controlling healthcare costs, quality of services and patient choice is an ongoing problem in healthcare.
References
Boudreau, E., Schwartz, R., Schwartz, A. L., Navathe, A. S., Caplan, A., Li, Y., Blink, A., Racsa, P., Antol, D. D., Erwin, C. J., Shrank, W. H., & Powers, B. W. (2022). Comparison of low-value services among Medicare Advantage and traditional Medicare beneficiaries. JAMA Health Forum, 3(9). https://doi.org/10.1001/jamahealthforum.2022.2935
Stephenson, J. (2022). Review identifies “noteworthy” differences in effects on patients of traditional Medicare vs Medicare advantage. JAMA Health Forum, 3(9). https://doi.org/10.1001/jamahealthforum.2022.4052
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