The Different Types of Managed Health Care Organizations - Essay Example

What are the various types of managed care organizations and how do these organizations differ in regards to services offered. Answer: Managed care organizations are the ones that have been formed for reducing the cost of the health care services. The aim of the managed care services is to deliver health insurance to the people who need them. (Nguyen 2009) The different types of managed health care organizations are listed below. The Health Maintenance Organization (HMO): The HMO is indeed considered to be the first among the managed care organization and these organizations grew at a very rapid pace. In this type of organization there is a very good interlinks that is formed between the hospitals, doctors as well as the various health insurance plans and mostly these three can be found in the same organization. In such cases it is found that the HMO will own the hospital and the salaries of the physicians are paid by them. Under normal circumstances, the patients have to go for the managed care plan that is being offered by the organization and only in very extreme cases, the patient can opt for other types of medical care providers. It has been widely seen that the HMO offers medical plans that are quite friendly to the pockets of the patients, since they force both the doctors as well as the patient to control the cost for the medical treatment that is to be undergone. As a result they are considered to be much more advantageous than other plans but at the same time they lack the quality aspect through the control of costs. (Nguyen 2009) Fee For Service or FFS: In this case of plan the patient can choose any doctor as well as any type of health care provider they wish. As a result the physicians are paid fees on each visit of the patient and in addition to this; the patients also have to pay for the various medical tests that they undergo. Hence in this case the patients though have their own choice, have to pay much higher than any type of medical plans. (Nguyen 2009) Independent Practice Association (IPA): In this case the physicians are not bound to any organization and hence can treat patients form both the HMO as well as the FFS. Preferred Provider Organization (PPO): In this case the doctors get very good business, since more number of patients will be routed to them and the patients will also get the benefit of having to pay lesser and get very good health care. (Nguyen 2009) Point of Service Plans (POS): POS is a plan in which the doctors need not work within the organization but all other aspects are the same as in the case of the HMO. If the patients are going for treatment in such kinds of organizations, then it is better for them to opt for the POS doctors since the patients have to bear extra costs in case they opt for an outside doctor. (Nguyen 2009) 2. Discuss the techniques these organizations use to contain costs. Answer: The most common cost controlling technique that is being followed by such organizations is to control as well as limit the number of health care provider’s network, which becomes very effective in controlling the costs and also helps in increasing the existing competition in the market. (Casto2009) The HMO types of organizations are very stringent in their rules and have made it mandatory that the doctors have to refer the patients to the specialist doctors with regards to their treatments. (Casto2009) Another type of cost controlling technique that is very commonly employed by the organizations is the Utilization Management, which is done by means of the pre authorizing of the services to the patients. Most of the plans that are charted out by the managed care organizations, have specific type of drug specified and the insurers keep such costs under control through price negotiations with big pharmaceutical companies. (Casto 2009) The most modern methods of cost control techniques that have been practiced by such organizations, is to incorporate the best scientific treatments with a very good and successful track record, maintain the records of the patients electronically, impart treatments within a certain time which is very much required in cases of chronic and serious types of diseases and many other techniques that help in controlling the costs. Apart form this the consumer driven health care plans are also proving to be very effective for such organizations, since in such cases the financial risk for the treatments is totally vested upon the patient. (Casto 2009) 3. Discuss the various ways physicians are reimbursed for services with managed care organizations. Answer: In the case of the HMO’s, the physicians are reimbursed by the organization which pay their fixed salaries. As a result most of the physicians working within the HMO feel that they lack the power to negotiate, since it is the organization which deals directly with the patients and sets their medical care plans. (Backus & Rosenburg) In the case of the Independent Practice Organization, the doctors work independently and they paid directly by the patients, depending on a case to case basis. In this case it is the doctors who fix their own payment rates. (Backus & Rosenburg) The doctors who work under the Fee for Service organizations also get payments, using the pay per service to the patients. In the case of Preferred Provider Organization the physicians have the benefit of getting a lot of business, by lowering the pay scale that they receive from the patients. (Backus & Rosenburg) The Point of Service organization doctors get remunerated and reimbursed for their services based on the number of patients that they get on a yearly basis. (Backus & Rosenburg) Indeed all the above said reimbursement and payment scales of the doctors are fixed, based on a series of negotiations that are held with them and the various managed care organizations ultimately determine the rates based on this. It is seen that today most of such doctors receive the payments which are either in the form of capitations as well as in the form of a blend of the various payments. Thus the reimbursements to the doctors are agreed in the form of contractual agreements, which are signed between the doctors as well as the managed care organizations. Works Cited: Casto, P. R, The Advantages of Managed Care Health Coverage, December17, 2009. Retrieved March26, 2011 http://www.livestrong.com/article/59877-advantages-managed-care-health-coverage/ Nguyen Giang, Guide to different Types of Managed Care Organizations, Published by Anurag Ghosh, July20, 2009. Retrieved March26, 2011 http://www.brighthub.com/health/technology/articles/7299.aspx Rosenburg, H, Ira and Backus, S, Michael, Managed Care Contracting – Reimbursement Models, Retrieved March26, 2011 http://www.mcres.com/mcrmcc03.htm Read More