Course Work Example on Managed Healthcare

Date:  2021-06-24 14:07:23
4 pages  (916 words)
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Managed Healthcare is a group of activities intended to reduce the cost of providing health care to the people. While at the same time, it aims at improving the quality of the care by providing techniques in carrying out the practice, The service has become an exclusive system in delivering and receiving American Healthcare since its implementation, and it has been largely unaffected by the Affordable Care Act of 2010 (Haas-Wilson 221). The primary intention of Managed Healthcare is to reduce the unnecessary health care costs through an array of mechanisms some of which include; economic incentives for physicians and patients to opt for the less costly forms of care, using programs for reviewing the medical necessity of specific services. Apart from the above mechanisms, there is also a selection of contraction with health care providers as well as intensive management of high-cost health care cases (Haas-Wilson 228). To ensure that the services highlighted were put into practice, an association of physicians known as Federal Trade Commission (FTC) launched complain to negotiate the prices by changing the insurance providers jointly.

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The FTC alleged in their complaint that the Association South West Alliance had violated the federal law by fixing the prices its members would charge insurers leading to higher prices for consumer and businesses. The growth of the health care was spurred by the enactment of Health Maintenance Organization Act of 1973.Managed healthcare probably is the first comprehensive exploration of the many issue and challenges faced by both providers and patient who work under the auspice of managed care (Kongstvedt 198). The type of payment that was implemented was not based on a particular procedure, nor hospital stay but rather on a per-member-per-month methodology. In the planned managed care environment, the plan negotiated with a large group employer and the government agency where the contract to cover the agreed upon population and provide all contracted service noted on the agreement which was set for fixed monthly fee per month. Due to the FTCs complaint, the actions and expectation of the Obstetrics &Gynecology Medical Corp in association with other bodies restrained the prices and other forms of competition among the OB/GYN in Nappa County.

Because of the reasons, the FTCs complained that the actions harmed the consumers including health plans, employers, and individual consumers by increasing the fees for the physician service. At the beginning of 1998, the FTC contends in its complaint of OB/GYNs in Nappa Valley Physicians (NVP) became dissatisfied with the level and timeliness of reimbursement from NVP (Kongstvedt 201). They decided to resign from the pact and later in the year formed a similar body to act in promoting among other things, their collective economic interest by increasing their negotiating power with NVP. The proposed order did allow the OB/GYNs to engage in conducting and collecting as well as determining the reimbursement and other terms of contra as deemed reasonably to enable operation of joint risk sharing (Haas-Wilson 230). Other terms were to see all physicians participants had to share substantial financial risk through the arrangement. Apparently, the FTC consent order barred the turn from misrepresentation of the online tracking or the ability of the user to limit or control the companys use of their data.

Due to the public outcry, the Federal Trade Commission had to approve the final settlement with a Redwood City, a Californian company over the charges that it deceived the consumers by tracking online through their mobile application even though the customers had taken steps to opt out of the tracking deal (Haas-Wilson 233).Even though the is was a matter within the public domain that information regarding the healthcare needed to remain as confidential as such, the handlers took to exploit the whole deal by introducing several companies forth to undertake the work. There was a reflection that the Centers for Medicare was exploitative and thus the interpretation of the statute and regulation about Medicare advantage to coordinate care plans for a particular individual with needs was to be set (Kongstvedt 210). The There was a reflection that the Centers for Medicare was exploitative and thus the interpretation of the statute and regulation about Medicare advantage to coordinate care plans for a particular individual with needs was to be set contractual procedures and elements required the processes by which the SNP agency to provide or arrange for Medical benefits as to be outlined in the contract between the State Medicare agency and the other entities.

The contractual element required the commitment to identify the dual-eligible population that was eligible to be enrolled. Finally, according to the complaint, OB/GYNs refused to engage in any activity that might justify the collective fee agreement that its members developed.Through the much-needed initiative, it is evident that the organization did not lobby for clinically nor financial integration of their practices to create efficiencies to offsetting their alleged anticompetitive actions. The proposed consent order preempted to the prevention of the reoccurrence of the allegedly illegal behavior but at the same time allowing the OB/GYNs to engage in legitimate contraction joint. On its core provision, the OB/GYNs were to be prohibited from entering participation or facilitating any agreement to negotiating on behalf of the physicians. Finally, the order also required that dissolution of the formed bodies done within a time limit.

Works Cited

Haas-Wilson, Deborah. Managed Care and Monopoly Power: The Antitrust Challenge. Cambridge, Mass: Harvard University Press, 2003. Internet resource

Kongstvedt, Peter R. Essentials of Managed Health Care. Sudbury, Mass: Jones and Bartlett Publishers, 2003. Print.

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