Managed Care-The role of managed care and integrated health system

Managed Care-The role of managed care and integrated health system

Managed care is a healthcare services delivery approach that seeks to utilize scarce resources through optimization in the care of patients. Healthcare is a highly competitive American business sector that has gaps as it pertains to customers’ needs. To satisfy these gaps, the healthcare insurers implemented various changes. Managed care in the sector was found to be a perfect solution for resource utilization, coordination of healthcare delivery, and implementation of systems that promote both preventive and curative care. Managed care was expected to deliver two solutions. First, it would offer cost savings in comparison to traditional insurance plans that purchasers used. This benefit would be realized through adherence to the detailed list of services, and benefits. The incentives for patients and physicians to observe the list ensured that resources were used carefully. The utilization of such resources was also monitored and controlled through obtaining preauthorization when planning to perform non-emergency procedures or prescribe expensive medication. Secondly, the managed care system would incorporate an integrated system of finance and delivery of preventive and curative care for chronically ill patients (Tobin, 1997). The claims database was comprehensive enough to allow assessment of economic and clinical outcomes as well as the implementation of improvements.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) pays attention to people’s thoughts and their connection to feelings and behaviors (NAMI, 2021). During a session, a psychologist’s goal is to reveal any unhealthy thought patterns and the resulting self-destructive behaviors. It strengthens self-awareness and enables the patients to develop coping strategies to deal with destructive tendencies. Patients develop confidence and identify effective stress-relieving strategies. It has been found to be effective in the management of insomnia, panic disorders, occupational stress, chronic pain, PTSD, phobias, problems related to substance abuse, severe mental conditions, depression, eating disorders, and relationship or interpersonal issues (Knapp & Beck, 2008). In 2017, studies established that CBT is ideal in increasing the brain regions’ connectivity. Some of the most affected parts of the brain include the amygdala as well as the frontal lobes. In 2018, studies confirmed improvement of emotion regulation among children with autism disorders (Wake Forest University, n.d).

Cognitive Therapy

Cognitive therapy (CT) is a significant aspect of contemporary psychology. CT operates on the assumption that cognitions have an effect on behaviors and emotions. The relationship between cognition and emotions is two-way because an alteration in one’s emotions affects cognitions. An individual’s perception of certain situations and events affects their emotions (Hoffmann, 2013). Dr. Aaron Beck played a critical role in developing CT through working with patients suffering from depression. CT is unique from other CBTs due to the connection between emotions and cognitions and their ability to influence each other. While CT teaches patients to disengage from negative thoughts or tame them, Dr. Aaron Beck identified various shortcomings. These distortions included categorization of experiences as good or bad, mind-reading, overgeneralization, and creation of ‘should’ statements. Psychologists should be in apposition to use evidence to correct such distortions (Dobson & Mastikhina, 2015).

Managed Care and Its Purpose

A managed care system is an integrated framework that incorporates delivery of care and financing through a clear set of health services. Any healthcare framework that enables providers to achieve efficient delivery of care while managing costs can be categorized as managed care. Various forms of managed care include health maintenance organizations (HMOs), preferred provider organizations (PPOs), point-of-service plans (POS), fee-for-service plans, and self-insurance plans. Managed Care Organizations (MCOs) achieve their objectives by controlling access to special care and getting rid of any unnecessary procedures and services (Tobin, 1997).

The main features of managed care include preauthorization, thorough utilization review, insistence on the use of physicians as well as other healthcare givers, quality improvement plans, and payment systems that ensure physicians are accountable for the quality and cost of specific medical services. Managed care has had a significant influence on various aspects of healthcare, including improved outcomes, reduction of health expenditure, and improved access to preventive and curative care. Reduction of health expenditure is realized when organizations create regulations that affect the delivery of preventative care, medication, and preferred methods of treatment. Eventually, organizations are able to deliver cost-effective care that addresses the needs of the patient population (Heaton & Tadi, 2021). The existence of incentives further the physicians’ desire to adhere to the policies that govern managed care in specific organizations.

Behavioral and cognitive approaches and managed care

Patients suffering from behavioral and mental conditions tend to receive poor healthcare services due to the high costs of care. Such patients are more exposed to progression into a chronic state, homelessness, poverty, unemployment, poor performance in academics, and involvement in crimes. Those with serious mental conditions tend to die 25 years earlier than those who do not suffer from such conditions. At least 20 percent of Medicaid enrollees have behavioral conditions. The Medicaid expenditure for patients with behavioral diagnoses exceeds the other expenditures by four times (Kelly, 2019). Despite the increased spending, such patients still experience gaps, which result in uncoordinated care, lack of information sharing between respective providers, and poor health outcomes. Such patients also access less preventive care and substandard quality of physical care. This disparity is subject to the effects of the stigma that arises from society.

This background highlights the role that managed care plays in the delivery of services to patients with behavioral diagnoses. As earlier stated, managed care intends to increase access to preventive and curative care through cost-effective means, which increases the likelihood of positive health outcomes. The high cost of care is linked to the expensive medication and numerous sessions that physicians recommend independently without inter-professional consultation. Thus, managed care offers a chance to eliminate these unnecessary medications and sessions. They only expose the patient to the important procedures, medications, and sessions and encourage information sharing among health care providers. This reduces the cost of care significantly because physicians must justify any expensive medication or excessive sessions and receive preauthorization for the same (Heaton & Tadi, 2021). Thus, managed care ensures that patients with behavioral conditions access healthcare easily and lead a better life.

Conclusion

Managed care is a healthcare improvement system that especially benefits patients with behavioral conditions. The healthcare sector is a highly competitive arena of business, with facilities and healthcare providers seeking to outdo each other in terms of profits. Very few players consider the plight of patients, their actual needs, and the necessity for positive health outcomes. Thus, managed care fills this gap by ensuring that physicians are conscious about the procedures they choose and the medications they prescribe. The procedures should be on a need basis and must be justified if they are too expensive. Accountability and information sharing enable patients to access cost-effective care and facilities to attend to their needs respectably.

References

Dobson, K. S., & Mastikhina, L. (2015). Concepts and Methods of Cognitive Therapies. International Encyclopedia of the Social & Behavioral Sciences, 4, 542-547. doi:10.1016/B978-0-08-097086-8.21047-7

Heaton, J., & Tadi, P. (2021, January). Managed Care Organization. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK557797/

Hoffmann, S. G. (2013). The Science of Cognitive Therapy. Behavior Therapy, 44, 199-212.

Kelly, L. (2019). Exploring the Impact of Integrated Medicaid Managed Care on Practice-Level Integration of Physical and Behavioral Health. Center for Health Care Strategies Inc. Retrieved from https://www.chcs.org/media/BH-Provider-Brief_070219.pdf.

Knapp, P., & Beck, A. T. (2008). Cognitive therapy: foundations, conceptual models, applications and research. Rev Bras Psiquiatr., 30, S54-64.

NAMI. (2021). Psychotherapy. Retrieved from https://www.nami.org/About-Mental-Illness/Treatments/Psychotherapy

Tobin, C. (1997). What is Managed Health Care? AADE News, 23(1). Retrieved from https://nfb.org//sites/default/files/images/nfb/publications/vodold/mngdcare.htm

Wake Forest University. (n.d). 6 Types of Behavior Therapy Used by Counselors Today.

ORDER A PLAGIARISM-FREE PAPER HERE

We’ll write everything from scratch

Write a 1,000-1,500-word paper about the role of managed care and integrated health systems. Include and address the following in your paper:

Managed Care-The role of managed care and integrated health system

A key theorist and a brief description of behavioral therapy.
A key theorist and a brief description of cognitive therapy.
A definition of managed care and a description of its purpose.
A discussion of how behavioral and cognitive approaches fit into managed care.
A minimum of three scholarly sources. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.