Effects of Managed Care on a Physicians’ Practice.

Describe the effects of managed care on physician’s practices. Do you see these effects as positive or negative? Why? Some effects are negatively affecting the care that physicians are able to provide their patients. In some patients are being denied health care coverage for health services by health plan providers because the provider does not believe that a severity of an illness is noticeable. For example: A teen tells his/her physician that they feel suicidal, but the mental health patient is denied health coverage because the provider does not think that the issue is severe, then commits suicide.It does happen. However, nat all effects are negative, in fact managed care increases the likelihood of that patients will get preventive medical services, like flu shots. But, problems do arise when a physician and the HMO disagree over authorizing a diagnostic procedure, like an MRI scan, or referring a patient to a specialist. When denials occur, health consequences to the patient can be “somewhat serious.

Managed care organizations require separate bookkeeping systems, tracking systems for preauthorization, up-to-date lists for referrals, special administrative procedures, copayments and fees for each plan contract, and special patient interviews to explain requirements. I do agree that these effects are positive because physicians know who is on the plan, how the account is being handled, if patients are making all the payments needed, and subscribers are able to gain information to help them choose what plan is right for them.Of the six managed care models, which one do you think is the best one to provide health care to a family with no current serious health problems? Why did you choose the one you did? There are five HMO models, direct contract model, group model, individual practice association, network model, and staff model. HMO models provide coverage for different groups of individuals. I think the HMO model is the best one to provide health care to a family with no current serious health problems because it provides comprehensive health care services to voluntarily enrolled members on a prepaid basis.HMOs provide preventive care services to promote good health thus reducing medical are costs. Also, health risk assessments are provided to subscribers, and subscribers are assigned to a PCP or personal care provider who is responsible for referring subscribers to other health care providers and for coordinating health care services.

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Another upside to HMO plans is that there is a less expensive copayment and sometimes there is not one at all. Green, Michelle A. /Rowell, JoAnn C.

2008 Understanding Health Insurance A Guide to Billing and Reimbursement Ninth Edition By: Melanie L.



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