The Managed Care Already Argument

One argument against managed care organizations is that the state of Arkansas has already implemented many of the cost-saving methods in its Medicaid programs that managed care organizations use. The issue can be confusing because health care professionals refer to these methods as “managed care,” but they don’t involve MCOs. The methods include: Utilization review, which is a process for determining whether a patient should get the care they or their doctors have requested. Prior authorization, which requires a doctor to obtain approval from his or her patient’s health insurance plan before prescribing a therapy to the patient. Provider networks, which are specific doctors and providers that an insurance plan has contracted with to provide medical care to its patients. Dr. Dan Rahn, chancellor of the University of Arkansas for Medical Sciences, pointed out that the managed care practices the state uses now also include “bundled payments.” These pay health care providers for treating an episode of illness — for example, a heart attack — rather than paying them for each service provided, or a fee for service. Bundled payments reward providers for working as a team to provide quality care rather than a quantity of care. Rahn also cited the Patient-Centered Medical Home Program, which primary care providers are also eligible to participate in. He said the program is yet another form of managed care employed by the state. This pro...
Source: Arkansas Business - Health Care - Category: American Health Source Type: news