Managed Care Organizations Essay

Managed Care Organizations Essay

This abstract is directed towards the Department of Health and Human Services regarding the use of a Managed care program to address the mental health issues of the underserved population.

One of the important considerations in healthcare is the need for a managed care program for the undeserved populations that concerns with mental health. This would include shifting the population from the current Medicaid programs to the managed care programs. The Medicaid programs are costly and have very poor accessibility. The use of managed care under the Medicaid services would greatly help reduces the costs of healthcare and meet the additional healthcare needs of the patients. The mental health needs of the underserved populations are huge and remain strongly undetermined. To meet such needs under the Medicaid program would mean higher costs and aiming the risks at one stakeholder (that is the taxpayer).

The stakeholders of the MCO program would include the Department of Health and Human Services, Center for Medicare and Medicaid Services (CMS), the MCO, Local Department of health contracting physicians, affected population, etc. Under these services, contracts would exist with physicians, psychiatrists and psychologists to provide comprehensive mental health services. This kind of a cost-sharing system would ensure that some amount of risks would be shared between the Department of Health and Human Services and the contracting MCO. The managed care organizations (MCO) would provide the existence of such packages and would ensure that the mental health outcomes are improved. The patients would also be getting incentives to use such facilities at a nominal cost. The quality of care, access to care, and efficiency of such a system is high and would ensure that the patients are benefitted. The main aim of such a program would be to improve the quality and access of healthcare, improve the general mental health of the undeserved population, improve the insurance coverage of the population and ensure that the expenditure under Medicaid is controlled. The services provided under the managed care umbrella would concentrate on preventive mental health, outpatient counseling and provision of medications, shorter hospitalizations and careful planning. The program would cover for counseling, preventive health services, prescription drugs and a few non-prescription drugs, hospitalization and ambulance transfer. The services of non-profit MCO’s that are approved by the state government or the federal government would be utilized. As the services often have to be provided to an individuals belonging to various cultures, every effort would be made to ensure cultural competency.

Managed care was first used by Dr. Michael Shadid in 1929 in Oklahoma, where he had developed a cooperative health package for families and provided them healthcare for a nominal fee. Later, the Department of Power and water used the services of Dr. Donald Ross to provide comprehensive health services to workers. In the 1930’s and 1940’s, the concept of HMO’s developed. Slowly the managed care organizations began to grow and it was in the 1970’s, 1980’s and 1990’s that employers and the government got interested. During the late 1990’s, the federal government and the state government considered using the MCO services for Medicare and Medicaid to reduce the costs of healthcare, covering the uninsured and providing access to the underserved populations. Using the services of the MCO to provide comprehensive mental health services to the underserved population would have immense number of advantages.

References

AMSA (2009). Health Care and the Underserved: America’s Poor and Managed Care, Retrieved on May 30, 2009, from AMSA Web site: http://www.amsa.org/pdf/hlthcareunderserved.pdf

Tufts Managed Care Institute (1998). A Brief History of Managed Care, Retrieved on May 30, 2009, from THCI Web site: http://www.thci.org/downloads/briefhist.pdf.

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