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Managed Care - Essay Example

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Recently it has become the center of American politics with the introduction of the Obama’s Health Plan. ‘Managed Care’ is the dominant health care delivery method in the United States…
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Managed Care

Accreditation is the significant process that Managed Care Organizations (MCOs) need to pass in order to prove their credibility and quality. Both, service providers and customers consider the certification as highly important because it indicates that an organization has attained the standard of quality defined by the accrediting agency. The major Accrediting Agencies in the United States are ABQAURP, NCQA & HEDIS, The Joint Commission, AAAHC & AAAASF and URAC.
Although the criteria for accreditation vary depending on the type of Managed Care Organizations and the accrediting agency, there are certain common factors that are applicable in the review. The Agencies usually consider the “MCO’s quality management program and its impact on operations, at utilization management and how it is carried out, at the MCO’s treatment of members and so forth.” (Kongstvedt., 2003 p. 239).
TRICARE is a managed care option of Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) initiated by Department of Defense (DOD). The service has been delivered through its worldwide Military Health Service System (MHSS). DOD provides Tricare civilian health benefits for military personnel, military retirees, and their dependents through its 11 health service regions. It has also established a new administrative structure to supervise the delivery of health care. (Kongstvedt, 2003 p.1131). Tricare Standard (Fee for Service Program), Tricare Extra (Preferred Provider Option), Tricare Prime (HMO Option), US Family Health Plan, and Tricare Reserve Select (TRS) are some of the major plans of Tricare. As compared to other managed care services in the United States, Tricare offers more steady high quality health care benefits and reduced costs. Tricare service is accessible according to the priority of the beneficiaries as follows; active duty members, family members of the active prime members, retirees and their family members, family ... Read More
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