Managed care is an arrangement whereby health insurance plans work in conjunction with health care service givers and health care facilities to give services to enrolled members at a lower cost (Birenbaun, 1997). There is increasing use of managed care in today’s health care provision hence the need to ensure its success.
According to Ayers and Benson (1995), ten practices would greatly improve the chances of success of managed care. These ten ways are further grouped into three; those practices which focus on strategic planning, those that focus on operations control, and those that focus on operations effectiveness.
In strategic planning, some practices take care of the structure, capital assets, and management team of managed care businesses. Provider integration is also essential for the success of managed care. The health care provider needs to form horizontal alliances, with others giving similar care, and vertical alliances, which puts all medical services under a single organization (Ayers and Benson, 1995)
The business of managed care has a huge capital requirement in terms of facilities, supplies, and even financial assets. Infrastructure management is, therefore, necessary to take care of these aspects of managed care business. A management team with true leadership and good negotiating abilities is needed in managed care to ensure the smooth running of operations. The lack of such a team would lead to the misappropriation of funds and hence poor performance of the managed care enterprises (Ayers and Benson, 1995).
Operations control deals with practices that help control cost and maintain the quality of services. There are four practices used to ensure effective operations control. Protocols are necessary for each managed care provider since they act as product definitions for the particular provider. Risk assessment is also useful as it helps in setting the cost and preparing for the future of the enterprise (Ayers and Benson, 1995).
Utilization measurement looks at information on services delivered. This information helps in cost control and optimization of health care services. Activity-based costing is another practice that provides for control of costs hence controlling profitability. This is necessary for the provider to control operations well. The compensation of members of a provider organization determines their behavior. Recognition and rewards also have an appositive impact on the behavior of members. These serve as incentives to both parties and lead to better performance (Ayers and Benson, 1995).
Operations effectiveness comes in to ensure that there is a balance between cost, service provision, and outcomes of the patients. The need for ready access to information necessitates proper information management. Information technology has roles in aspects of administration, accounting, community networking, clinical interface, and data interchange. Reengineering in all areas of managed care leads to improvements in the process of managed care. It entails changes in service provision with a positive impact on time and cost. Quality assurance from the managed care providers is important as there is a need to keep high standards of service delivery to customers (Ayers and Benson, 1995).
For the success of managed care, the ten practices proposed by Ayers and Benson (1995) need to be implemented. However, it is not easy to implement all of them. This leaves a desire for methods that are easier to implement. The practitioner’s best interests may not be well taken care of due to the big number of personnel needed and they may feel dissatisfied.
References
Ayers, J. and Benson, L. (1995). A road map for managed care success: administrative radiology, AR, 14, 8, 31 -7.
Birenbaum, A. (1997). Managed care: Made in America. Westport, Conn: Praeger.