The United States spends a lot of money on healthcare, more than a lot of other countries, but does not have positive health outcomes to show for it
The United States spends a lot of money on healthcare, more than a lot of other countries, but does not have positive health outcomes to show for it (Namburi & Tadi, 2023). Managed care was implemented to help cut costs associated with healthcare, but also improve the health outcomes of Americans. Managed care is when insurance companies partner with specific providers or healthcare organizations to provide quality care to patients at a reduced rate (Namburi & Tadi, 2023). The reduced rate can be achieved by the patient by seeing what is called an in-network provider; if a patient sees an out-of-network provider they are going to pay more (Namburi & Tadi, 2023). Managed care also increased the number of for-profit healthcare organizations (Namburi & Tadi, 2023). For-profit healthcare organizations typically charge more for their services but do not offer any better-quality care than their non-profit counterparts (Healthcare Management Degree Guide, 2021).
Another cost-containment effort for primary care offices is the development of ACOs (affordable care organizations). ACOs are outside companies that independently owned (not owned by a hospital organization) primary care offices pay to be a part of that help to manage the care of all of the patients that are attributed to their office. ACOs are not insurance companies or healthcare providers, they simply manage data. They process billing codes that are submitted to a patient’s insurance and help determine the next steps to prevent overspending on healthcare services. For example, a patient who is seen in the emergency department or discharged from the hospital will need a transition of care appointment. The ACO will notify the office of the need for this appointment within 24 hours, hopefully, sooner, that a discharge occurred so they can reach out to the patient and schedule an appropriate follow-up (LaPointe, 2019). This appointment is used to decrease hospital readmission rates due to medication adherence issues or lack of services available to the patient (10 Common Causes for Hospital Readmissions, n.d.). ACOs also provide patients who are not compliant with their preventive care. The idea behind this is preventive screenings offer early identification of any abnormalities.
Managed care plans and ACOs are both intended to save the patient and the insurance company money on healthcare spending. ACOs also offer to improve patient outcomes while decreasing healthcare spending. However, the cost of joining an ACO can be expensive for an independently owned-primary care practice. While an ACO is required by some insurance providers and primary care providers can receive a portion of the shared savings (How Are ACOs Different From HMOs?, n.d.), it really is an important cost-saving strategy that benefits the patient.
References
10 common causes for hospital readmissions. (n.d.). Right at Home. Retrieved August 1, 2023, from https://www.rightathome.net/blog/10-common-causes-hospital-readmissions
Healthcare Management Degree Guide. (2021, August 4). Are Non-Profit or For-Profit hospitals better? Retrieved August 1, 2023, from https://www.healthcare-management-degree.net/faq/are-non-profit-or-for-profit-hospitals-better/
How are ACOs different from HMOs? (n.d.). International Council for Quality Care. Retrieved August 1, 2023, from https://www.icqc.org/how-are-acos-different-from-hmos/#:~:text=An%20ACO%20is%20not%20a,ACOs%20are%20part%20of%20Medicare.
LaPointe, J. (2019, December 18). Understanding the fundamentals of accountable care organizations. Revcycle Intelligence. Retrieved August 1, 2023, from https://revcycleintelligence.com/features/understanding-the-fundamentals-of-accountable-care-organizations
Namburi, N., & Tadi, P. (2023, January 30). Managed care economics. StatPearls – NCBI Bookshelf. Retrieved August 1, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK556053/
Paper Format: APA
Answer preview to The United States spends a lot of money on healthcare more than a lot of other countries but does not have positive health outcomes to show for it
APA
365 words