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Discuss 3 current trends and directions for healthcare delivery in the United States and the role that managed care has in shaping those 3 trends.
Besides managed care, what other forces have influenced these trends and directions?
Are these trends and directions moving healthcare delivery in a positive direction? Explain your response
Healthcare delivery in the United States is currently being shaped by several trends, with managed care playing a significant role in each. Managed care, which includes organizations like HMOs and PPOs, aims to control costs and improve the quality of care by managing how and where patients receive services.
Trend: The U.S. healthcare system is moving away from the traditional fee-for-service (FFS) model, where providers are paid for each service they perform. The new direction is value-based care, which rewards providers for patient outcomes, health improvements, and cost-effectiveness.
Managed Care's Role: Managed care has been a primary driver of this trend. By using capitation (a fixed payment per patient) and quality bonuses, managed care organizations incentivize providers to focus on preventative care and managing chronic diseases, as this keeps patients healthier and reduces overall costs. They push providers to deliver care that is both high-quality and efficient.
Other Influences: Besides managed care, government initiatives like the Medicare Access and CHIP Reauthorization Act (MACRA) have accelerated the shift. This legislation ties Medicare payments to a new system that rewards quality and value. Additionally, large employers are increasingly demanding better value for their healthcare spending, which encourages providers to adopt this new model.
Trend: Healthcare is moving towards a more integrated and coordinated system. Instead of fragmented care where a patient sees multiple specialists who don't communicate, the trend is toward Accountable Care Organizations (ACOs) and integrated health systems where all providers work together to manage a patient's health.
Managed Care's Role: Managed care promotes this integration by establishing preferred provider networks and creating incentives for providers within a network to share information and coordinate treatment. This reduces redundant tests and ensures that a patient’s care plan is consistent across different providers.
Other Influences: Technological advancements, particularly the widespread adoption of Electronic Health Records (EHRs), have made care coordination much easier. Patients themselves are also demanding a more seamless healthcare experience.
Trend: The use of telehealth (virtual visits), remote patient monitoring, and other digital health tools has rapidly expanded, particularly since the COVID-19 pandemic. This trend aims to increase access to care and reduce costs.