NU 503 Discussion 3 Question 1
NU 503 Discussion 3 Question 1
The enactment of legislations like the Affordable Care Act 2010 was meant to reduce the cost of healthcare through expansion of access to primary care. As a result of these reforms, initial cost-reduction models like managed care organizations (MCOs) were bolstered to enhance their efforts through increased resource availability. Managed care organizations are incorporated into the healthcare system with the focus on reducing health care cost expenditures (Heaton & Tadi, 2021). Managed care organizations include health maintenance organizations (HMOs) preferred provider organizations (PPOs) and point of service organizations (POs). Studies show that these entities have reduced cost of healthcare through their innovative approaches and models that offer incentives to providers and their networks and increased access to patients through the varied options that they ca
NU 503 Discussion 3 Question 1
n select to access healthcare services. In their study, Stadhiuder et al. (2019) posit that managed care organizations have been cost-effective and stakeholders should use a combination of cost sharing approaches and emphasize the need for reforms. In their findings, Nathan et al. (2019) note that early interventions like the establishment of managed care organizations and accountable care organizations have improved overall access to care while reducing the cost of treatment for different patients accessing healthcare services.
Despite their benefits, these cost-saving approaches or measures face barriers or challenges due to reforms by the
NU 503 Discussion 3 Question 1
Centers for Medicare and Medicaid which require providers to focus on value as opposed to quantity for their reimbursements (McConnell et al., 2017). Further, the rapid increased in different care models like accountable care organizations have eroded gains made by the MCOs as they serve as substitutes to the current situation due to increased demand for healthcare services (Nathan et al., 2019). The efforts of these entities have been on primary care with limited resources for chronic disease conditions.
References
Heaton, J. & Tadi, P. (2021). Managed Care Organizations. StatPearls [Internet].
https://www.ncbi.nlm.nih.gov/books/NBK557797/
McConnell, K. J., Renfro, S., Chan, B. K., Meath, T. H., Mendelson, A., Cohen, D., … &
Lindrooth, R. C. (2017). Early performance in Medicaid accountable care organizations: a comparison of Oregon and Colorado. JAMA internal medicine, 177(4), 538-545.
doi: 10.1001/jamainternmed.2016.9098.
Nathan, H., Thumma, J. R., Ryan, A. M., & Dimick, J. B. (2019). Early impact of Medicare
accountable care organizations on inpatient surgical spending. Annals of surgery, 269(2), 191. doi: 10.1097/SLA.0000000000002819
Stadhouders, N., Kruse, F., Tanke, M., Koolman, X., & Jeurissen, P. (2019). Effective healthcare
cost-containment policies: a systematic review. Health Policy, 123(1), 71-79. https://doi.org/10.1016/j.healthpol.2018.10.015