Managed care is also known as managed health care; it is the type of health insurance scheme and system that delivers healthcare services at a subsidized/minimized cost, specifically in the United States of America (Chung, 2022). Also, managed care is referred to as an organized system of health care that focuses on reducing or eliminating services that are deemed unnecessary or ineffective to reduce care costs and maintain quality services.
Managed care is carried out in either of the following health organizations; Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs) (Chung, 2022). The organizations use various methods and strategies to finance the healthcare services and organize specific health care delivery in every situation to control health costs. It relies on the following strategies for success; utilization strategies, selective contracting, and economic incentives (Chung, 2022).
Under selective contracting, managed care organizations select health care systems and health providers who charge the lowest to provide health services to their members. Also, these organizations provide innovative economic incentives to health workers and patients to encourage the selection of less costly healthcare services (Chung, 2022). Finally, managed care organizations have developed technology to monitor the prices and quality of services in their health care institutions. These have enabled the managed care organization to establish the necessity of services and possible options hence controlling and reducing healthcare costs.
Initiatives Implemented by Private Insurers to Transform Healthcare
Currently, most of the United States population has health insurance coverage provided by private insurance companies. It includes “non-elderly people with employer-sponsored coverage or individually purchased health insurance plans; low-income Medicaid enrollees covered by managed care organizations; people age 65 and older and younger adults with disabilities in Medicare Advantage plans; and people in traditional Medicare who also have private insurance, such as Medicare part D stand-alone prescription drug plans, supplemental (Medigap) policies, or employer-sponsored retiree health coverage” (Pollitiz et al., 2022). Through these initiatives, most of the population can access healthcare services transforming and impacting healthcare positively.
Roles Nurses Play to Improve Quality Patient Outcomes
Nurses are the ones responsible for coordinating healthcare with other health workers. They manage patients in hospital settings and even help them transition after referral or discharge. Also, they reduce healthcare costs by eliminating unnecessary and expensive hospital readmissions, preventing medical errors, provide appropriate patient-centered services (Johnson, 2022). Furthermore, nurses educate patients on available and best insurance schemes according to their needs. These have helped increase patients’ access to quality care, improving patient outcomes.
Strategies Nurses Can Use to Advocate for Healthcare Consumers and Reduce The Increasing Cost of Healthcare
Healthcare systems need to be conscious of the costs of services without necessarily sacrificing healthcare consumers (Arkansas, 2022). Cost-conscious health institutions are more stable. The stability helps them to provide quality care services to its consumers. Nurses are the majority population in ideal health settings. They have a major role in ensuring costs of services are bearable to the health consumers. The following are strategies that nurses can implement to reduce the increasing cost of healthcare; using electronic devices to produce, send and keep patient information to reduce the cost of paper works, ensuring the nursing department operates on a budget, reducing waste, creating adequate staff schedules to avoid over times and seek out lower-cost employee benefits (Arkansas, 2022).
Arkansas, W. (2022). What Is the Nurse’s Role in Cost-Conscious Care?. A-State Online. Retrieved 1 March 2022, from https://degree.astate.edu/articles/nursing/what-is-the-nurses-role-in-cost-conscious-care.aspx.
Chung, K. (2022). managed care | health insurance and system. Encyclopedia Britannica. Retrieved 1 March 2022, from https://www.britannica.com/topic/managed-care.
Johnson. (2022). Retrieved 1 March 2022, from https://www.rwjf.org/en/library/articles-and-news/2015/01/nurses-take-on-new-and-expanded-roles-in-health-care.html.
Pollitiz, K., Neuman, T., Tolbert, J., & Rudowitz, R. (2022). What’s The Role of Private Health Insurance Today and Under Medicare-for-all and Other Public Option Proposals?. KFF. Retrieved 1 March 2022, from https://www.kff.org/health-reform/issue-brief/whats-the-role-of-private-health-insurance-today-and-under-medicare-for-all-and-other-public-option-proposals/.
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