Managed Care And Disease Prevention – WITH Outline
Please use the following outline to write a 5-7 page report on the role of preventive medicine in managed care. Please write in APA format, including in-text citations and a reference page at the end. Introduction
Even though the cost barriers for insurance premiums these days ultimately prevent some individuals from obtaining preventive health care services, the Affordable Care Act requires that private insurance plans cover recommended preventive services at no cost to the patient.
The coverage requirement attempts to remove cost barriers by reminding physicians and Managed Care Organizations (MCOs) of the theory behind managed care practices.
A principle behind the theory of managed care is that combination of primary care and preventive care would reduce the need for costly chronic care (1). Body
Research has shown that evidence-based preventive services can save lives and improve health by identifying illnesses earlier, managing them more effectively, and treating them before they develop into more complicated, debilitating conditions (2).
Some services are also cost-effective, such as routine preventive screenings which facilitate the management of chronic diseases like tuberculosis or COPD.
The physician plays a pivotal role in preventive services, such as mammograms, and many physicians become contracted with an MCO and retain the same patients long-term.
Although the ACA requires these physicians offer free preventive services, the differences in which services actually qualify as preventive is confusing for patients and doctors alike.
Prevention of crises that require hospitalization or expensive long-term services reduces costs for both the MCO and the consumer, emphasizing the long-term value of preventive services and putting a positive spin on the consumer’s perception of MCOs.
MANAGED CARE THESIS AND OUTLINE
The potential influence of prevention in calculating the morbidity and costs associated with chronic disease is substantial, potentially averting 70 percent of such cases. A large proportion of the chronic diseases of concern is preventable, providing an opportunity to exploit prevention as a strategy to bend the curve and reduce growth in disease burden and its associated costs (3). Conclusion
A comprehensive approach to prevention necessitates clinical and behavioral interventions. Although the challenge for managed care plans to standardize preventive medicine has yet to be accepted, managed care plans have done more to promote prevention than fee-for-service medicine ever did (4). However, the medical community – physicians, plans, and purchasers – seems to lack a unified vision of what constitutes appropriate preventive care. The need for costly chronic care is still evident, even while Managed Care Organizations offer incentives which emphasize the long-term value of preventive services.