Managed Care Trends/Issues Analysis
Description
Managed Care Trends/Issue Analysis
Prepare a five-page paper in
which you research and evaluate what you believe to be the top three most
significant trends/ issues in managed
care today. Justify, providing explanations for your three
choices. Include three to five reference sources (excluding the course text)
that have been written within the past three to five years.
[Instructor’s Tips]
This assignment does ask you
about the top three most significant trends/ issues in managed care
today (2018). Managed care should refer to a variety of
approaches intended to reduce the cost of providing health benefits, coordinate
better care, and improve the quality of care.
Managed
care is not interchangeable with managed care organizations such as HMOs, PPOs
or POSs. Managed care is also not interchangeable with the U.S. healthcare
delivery system. I used to work for Magellan, the largest managed behavioral
healthcare organization in the US. Magellan is not an insurance company.
Magellan is a managed
care organization that manages mental/behavior health
benefits for Medicare, Medicaid, and major insurance companies that offer HMO,
PPO, POS, and indemnity plans. Magellan also manages employee assistance
programs for many Fortune 500 companies. Magellan has employed utilization
review and case management to control the cost of mental/behavioral healthcare
and ensure that quality of mental/behavioral healthcare is provided to the
patients.
Have you heard
about disease management that is one main essence of managed care? Have you
heard about health wellness programs? Under the Affordable Care Act,
managed care organizations have promoted health wellness programs intensively.
Have you heard about utilization review? Have you heard about case
management? Have you ever heard about Accountable Care Organizations
(ACOs) or patient-centered medical homes? ACOs and patient-centered
medical homes are new managed care models. Are they similar to HMOs, but they
are not the same. HMOs focus on control costs, while ACOs and patient-centered
medical homes have an emphasis on improving quality of care with evidence-based
practices. Once improving quality of care is done correctly with evidence-based
practices, the cost of providing healthcare will be reduced.
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References:
Nursing Standards
Nursing and Midwifery Board of Australia. (2018). Code of conduct for midwives. https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx
Clinical Guidelines
Guideline Adaption Committee. (2016). Clinical practice guidelines and principles of care for people with dementia. NHMRC Partnership Centre for Dealing with Cognitive and Related Function Decline in Older People. https://cdpc.sydney.edu.au/wp-content/uploads/2019/06/CDPC-Dementia-Guidelines_WEB.pdf
Living Guideline
Stroke Foundation. (2022). Australian and New Zealand living clinical guidelines for stroke management – chapter 1 of 8: Pre-hospital care. https://app.magicapp.org/#/guideline/NnV76E
Evidence-based practice
BMJ Best Practice
Goldfarb, S., & Josephson, M. (2020). Cystic fibrosis. BMJ Best Practice. https://bestpractice.bmj.com/
Schub, T., & Cabrera, G. (2018). Bites: Head lice [Evidence-based care sheet]. Cinahl Information Systems. https://www.ebscohost.com
Beyea, S. C., & Slattery, M. J. (2006). Evidence-based practice in nursing: A guide to successful implementation. http://www.hcmarketplace.com/supplemental/3737_browse.pdf
JBI: Evidence summary
Swe, K. K. (2022). Blood glucose levels: Self-monitoring [Evidence summary]. JBI EBP Database. https://jbi.global
JBI: Best practice information sheet
Bellman, S. (2022). Experiences of living with juvenile idiopathic arthritis [Best practice information sheet]. JBI EBP Database, 24(1), 1-4.
Cochrane Database of Systematic Reviews
Srijithesh, P. R., Aghoram, R., Goel, A., & Dhanya, J. (2019). Positional therapy for obstructive sleep apnoea. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD010990.pub2
Drug Information
Codeine. (2023, January). In Australian medicines handbook. Retrieved February 2, 2023, from https://amhonline.amh.net.au
Colorado State University. (2011). Why assign WID tasks? http://wac.colostate.edu/intro/com6a1.cfm
Dartmouth Writing Program. (2005). Writing in the social sciences. http://www.dartmouth.edu/~writing/materials/student/soc_sciences/write.shtml
Rutherford, M. (2008). Standardized nursing language: What does it mean for nursing practice? [Abstract]. Online Journal of Issues in Nursing, 13(1). http://ojin.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/Health-IT/StandardizedNursingLanguage.html
Wagner, D. (n.d.). Why writing matters in nursing. https://www.svsu.edu/nursing/programs/bsn/programrequirements/whywritingmatters/
Writing in nursing: Examples. (n.d.). http://www.technorhetoric.net/7.2/sectionone/inman/examples.html
Perth Children’s Hospital. (2022, April). Appendicitis [Emergency Department Guidelines]. Child and Adolescent Health Service. https://www.pch.health.wa.gov.au/For-health-professionals/Emergency-Department-Guidelines/Appendicitis
Department of Health. (n.d.). Who is being active in Western Australia? https://ww2.health.wa.gov.au/Articles/U_Z/Who-is-being-active-in-Western-Australia
Donaldson, L. (Ed.). (2017, May 1). Healthier, fairer, safer: The global health journey 2007-2017. World Health Organisation. https://www.who.int/publications/i/item/9789241512367
NCBI Bookshelf
Rodriguez Ziccardi, M., Goyal, G., & Maani, C. V. (2020, August 10). Atrial flutter. In Statpearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK540985/
Royal Perth Hospital. (2016). Procedural management: Pre and post (24-48 hours) NPS. Canvas. https://courses.ecu.edu.au
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