Explore BrainMass

Explore BrainMass

    Manage Care Issues

    This content was COPIED from BrainMass.com - View the original, and get the already-completed solution here!

    I need help with the following. I am having trouble finding resources so as much info as you can get would be great.

    "Analyze 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".

    Thank you.

    © BrainMass Inc. brainmass.com December 15, 2020, 5:34 pm ad1c9bdddf

    Solution Preview

    The following can serve you as a start for the project. It contains the basic structure with trends that can be expanded.
    As requested, I have included as much information as I could with resources.
    Hope this can help you. Thanks for using BrainMass.

    Managed care comprises a large variety of arrangements that can combine the functions of health insurance and the actual delivery of care, "where costs and utilization of services are controlled by such methods as gate keeping, case management, and utilization review" (Shi & Singh, 2002, p.590). It is shaped by two major forces, the government and the market. The government imposes rules and regulations that managed care has to comply, and the market dictates strategies that depending on the current time can go from survival to profitable.

    The latest trend in managed care has to deal are the Government's recommendation for standards for culturally and linguistically appropriate services (CLAS). It is a response to the changing face of the demographics, market and an effort to establish a public health measure that ensures that all people entering the health care system receive equitable and effective treatment in a culturally and linguistically appropriate manner. The linguistically and appropriate services have already been incorporated as part of the policies for JACHO's accreditation. JACHO stands for The Joint Commission on Accreditation of Healthcare Organizations (JACHO), an independent non-profit organization that had been promoting health policy regulations. Up to 1965 the accreditation was voluntary and obtaining accreditation was seen as a reputable move to show the accredited health care provider was providing the highest possible health care quality services. Things changed when Congress passed the Social Security Amendments of 1965 stating that "hospitals accredited by JCAHO are 'deemed' to be in compliance with most of the Medicare Conditions of Participation for Hospitals and, thus, able to participate in the Medicare and Medicaid programs" (The Joint Commission, 2010 ¶13). The voluntary nature of the accreditation became a must for health care providers that received Medicare payments. From there on, rules and regulations have become a standard in health care forcing managed care to comply with them. Failing to pass a JACHO's accreditation process can mean suspension of payments by the government or revoking state permit and licenses of the health care provider until the failed measurements are ...

    Solution Summary

    The solution involves brief discussion of 3 trends/issues that affect managed care today and resources that can help the student deepen the analysis and evaluation of those issues.