Managed Care Finances, Drawbacks and Features

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Managed Care

Explain the major features of a consumer-driven health care plan (CDH).
Consumer-driven health care plan (CDH) is a method to try and curb the costs of
healthcare. Many providers have analyzed those who use CDH and find that the plans save
money for both the employers and employees. Reindl discredits the myth that CDH plans pick
the healthier clients as part of their patient population. Study data show that these plans do
cover a broad range of chronically ill patients along with other types of more healthy adults
(2010).
CDH is often thought to discourage patients from seeking care. Data from CIGNA
healthcare show that their patient population receives higher than average numbers of physician
visits and preventative treatment (Rendl, 2010). Supporters of CDH feel that having this type of
healthcare market can put patients in better control of their expenditures for medical care in light
of future trends in this system (Munn, 2010). It was also reported that the cost of medical care in
a CDH was projected to be at least a 14% cost savings in certain markets versus traditional plans
(Reindl, 2010). The significant measure for any successful plan is high levels in standards that
reflect evidence-based care. This is the true measure of quality. If the patient perception of a
successful practice and outcome supersedes other experiences then that is where significance lies
in client care.
Discuss three major critics/drawbacks of managed care.
The managed care concept came into existence with the beginning of the Health
Maintenance Organizations (HMOs). According to Rodwin (2010), many writers suggest that
we are now in a post Medicare and Medicaid stage but all the markers of these systems are still
in place. The central themes of this are the challenges of physician entrepreneurship and
the ability for patients to voice their care. Before managed care, a patient had the ability
to move from one physician or healthcare system to another if they did not feel they were treated
to their satisfaction. Now, it is not that simple. The patient must work within their own HMO or
pay extra fees for using a physician or hospital out of their system. The patient can change
systems but if they work for a particular company that has a contract with an HMO, they have no
choice but to pay (Rodwin, 2010).
"In 1970 there were 3 million HMO enrollees, and by 1976, only
6 million in federally qualified HMOs. Then, Congress dropped the
requirement that HMOs have open enrollment and community rating
and reduced requirements for services they must cover. Still, by 1980,
there were only 9.1 million enrollees. But by 1990, HMOs covered
33.6 million individuals and by 2000 over 80 million (Rodwin, 2010)".
Up until the early 1970s, a patient could still visit a physician for fee for service. After
the Medicare bill was enacted in 1965, this is when the dynamics of medicine as we know it
began to change. This was still a time when professional ethics deterred a physician or
healthcare system from advertising their systems. It was still a time of passive physician patient
relationships when patients were not encouraged to as questions and accept the physicians care
plan.
As it became more difficult to control the costs of medical treatments and consistencies
of prices from one to another, the insurance companies emerged with a price per illness or
capitation. Blue Cross and Blue Shield were one of the first insurance companies to try this
program. Obviously, this was not met with a lot of enthusiasm and went through many stages
to the point it is today (Rodwin, 2010). Most people who pay for insurance even within a
company or package plan are paying more or they are getting less for their dollar. This does not
sustain the idea that a managed care system is saving money for the consumer (Geyman, 2012).
There are several types of plans that can be used. Some are restrictive and others more
flexible. An HMO will usually pay for your care that is rendered within the network. You ...