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Reply prompt: Respond to the two discussion questions from classmates who reached a different conclusion than you did. Identify the points of difference in your analyses and explain how your sources and analysis led you to your conclusion. Replies must be at least 450 words each discussion reply. Each reply must reference at least 3 scholarly sources and follow current APA format (including both in-text citations and a reference list). You must also support each reply with thoughtful analysis (considering assumptions, analyzing implications, and comparing/contrasting concepts and include thorough biblical worldview integration.

 

Discussion Question #1

Introduction

Managed health care is defined as “a mechanism of providing health care services in which a single organization takes on the management of financing, insurance, delivery and payment “(Shi &Singh, 2017). The first health maintenance organization (HMO) is said to have been the Western Clinic in Tacoma Washington in 1910. It offered a range of medical services to lumber mill owners and their employees for a cost of fifty cents per month (Fox & Kongstvedt, 2007). The HMO act of 1973 introduced the capitation system as opposed to the fee- for service system to help reduce the increasing cost to Medicare. The full effects of the act were not enacted until 1977 at which time the number of HMO’ s bean to rise. The preferred provider organization (PPO) entered the game in the late 70’s and early 80’s (Fox & Kongstvedt, 2007).

Explain the growth of managed care that began in the 1980’s

The growth of managed health care in the 1980’s was due to the out of control increases in health care. The consumer price index rose by 59% but medical care was up 117% (Shi &Singh, 2017). Most companies began to use the MCO’s to help decrease the health care costs because they were affecting the profitability of the company. Medicare and Medicaid began to use MCO’s to control costs but also to ensure quality of care based on patient need not the current fee for service where physicians would order unnecessary tests or procedures (Shi &Singh, 2017). During the last of the 1990’s MCO’s began to decline due to public opinion concerning the quality of care and the amount of control the MCO’s had over the reimbursement and utilization aspects pertaining to hospitals and physicians.

How has health care delivery evolved?

The future of health care delivery will see an increase in various types of managed care options ranging from the long time HMO and PPO to the newer Accountable Care Organization (ACO) and the Patient-Centered Medical Home (PCMH). The ACO is an integrated delivery system (IDS) that includes hospitals, physicians and post discharge care. The ACO must be a legal entity and have a governing body to provide oversight (Shi &Singh, 2017). PCMH’s focus on the patient beyond their medical needs. “Each patient is unique and will have specific needs” (Rusnuck,2017). The practice must be: physician-led, comprehensive, coordinated, accessible, and committed to quality and safety(Rusnuck,2017).

Based on the literature, what does the future hold?

As our population grows and ages we will need a solid health care system to provide the best quality care while controlling costs. As Aristotle said, “The whole is greater than the sum of its parts.” It will take a community effort on the part of the financing, insurance, delivery and payment groups to achieve the ultimate health care product. We can expect for MCO’s to continue to shape our health care system. There will be a continuing push for quality of life for   patients and incentives and accountability for health care providers.

Conclusion

Philippians 2:4-7 states “Don’t look out only for your own interests, but take an interest in others, too. You must have the same attitude that Christ Jesus had. Though he was God, he did not think of equality with God as something to cling to. Instead, he gave up his divine privileges; he took the humble position of a slave and was born as a human being. When he appeared in human form.” If we can develop a strong managed heath care plan with this verse in mind we may be able to have a plan that will benefit the investors as well as the patient. (word count 609)

References

A quote by Aristotle. (n.d.). Retrieved August 10, 2017, from

https://www.goodreads.com/quotes/20103-the-whole-is-greater-than-the-sum-of-its-parts.

Fox, P., & Kongstvedt, P. (2007). The Essentials of Managed Health Care (Fifth ed.). Sudbury,

MA: Jones and Bartlett.

Rusnak, W., M.D. (2017, March 22). How Patient-Centered Medical Homes Are Transforming Primary Care. Retrieved August 10, 2017, from https://www.nuemd.com/blog/patient-centered-medical-homes-transforming-primary-care.

Shi, L., & Singh, D. (2017). Essentials of   the U.S. Health Care System (Fourth ed.). Burlington, MA: Jones &   Bartlett Learning.