MANAGED CARE

By Karoonskie
Group 8
 Why Managed Care?
Managed Care is a health care delivery system organized to manage
cost, utilization, and quality. Medicaid managed care provides for the
delivery of Medicaid health benefits and additional services through
contracted arrangements between state Medicaid agencies and
managed care organizations (MCOs) that accept a set per member per
month (capitation) payment for these services.
By contracting with various types of MCOs to deliver Medicaid
program health care services to their beneficiaries, states can reduce
Medicaid program costs and better manage utilization of health
services. Improvement in health plan performance, health care
quality, and outcomes are key objectives of medicaid managed care.
Some states are implementing a range of initiatives to coordinate and
integrate care beyond traditional managed care. These initiatives are
focused on improving care for populations with chronic and complex
conditions, aligning payment incentives with performance goals, and
building in accountability for high quality care.
 Cost and Quality of M.C.
The cost and quality of Managed Care surely
depends on what country, of course, US having the
most spent in Managed Care.
So far, the US has the most advanced, and has the
most Quality among all the countries.
There is too much evidence, on how the US is one of
the best, in fact second to none in Managed Care
quality.
As the quality further improves, the price is, well
improving too.
Efficiency is the main key in terms of the Cost and
Quality of Managed Care.
Contractual Reforms to Reduce cost

If the cost of managing your Health is high enough,

why not lessen the cost while keeping the same
quality, this is the main point of Contractual Reforms
It also simply means one group (buyers) is paying
less, and thus another group (sellers) receives less.
Buyers are happy to pay less, but sellers/providers
are not so happy to receive less. Basically the
conflict of this topic.
It is most likely to produce harm and
misunderstanding, therefore in most cases,
Contracts are used.
 Reforming the Organization to
Reduce Cost
Basically reduces the cost by using some
organization.
MCO pays bills and having a set of
hospitals and physician that provide care.
CPGP (Closed-Panel Group practice) the
physicians work on salary for the
organization, the hospitals are owned by
the organizations, and the drugs are
purchased by the organization.
 Sources and Uses of Funds
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