Introduction
The medical-managed care plans in the American healthcare system are considered pivotal players. These plans aim to address various healthcare needs of patients, especially among individuals with low incomes. The medical-managed plans help to provide equal access to healthcare services among citizens. The quality of care, as well as its cost, can be controlled, and different challenges that occur can be addressed. This paper aims to research medical-managed plans in the healthcare industry, the challenges in this area that contribute to the quality, cost, and access to healthcare services, and various recommendations that can be utilized to improve these plans.
Programs
Medical-managed care plans play a vital role in Medicaid programs, as they ensure that each person has enough coverage for their needs in healthcare. Medicaid plans are intermediaries between healthcare providers and the government and serve as a tool to provide various services in the healthcare industry for people who need them (Medicaid Expansion and Health Plan Quality in Medicaid Managed Care, n.d.). This program is essential in the healthcare industry, significantly affecting the healthcare delivery system.
For instance, this program expands healthcare coverage for those who need them. These plans help to effectively coordinate care and provide valuable services for eligible populations (Medicaid Expansion and Health Plan Quality in Medicaid Managed Care, n.d.). In this case, care managers should constantly analyze the healthcare needs, improving the services offered. All these goals are achieved by establishing special payments to the healthcare providers, so the cost-effectiveness and healthcare delivery are increased.
Challenges
However, these plans face significant challenges that affect efficiency and create complexities. The major challenge is ensuring equal access to healthcare services for all individuals. For instance, some regions have limited access to the Medicaid program, resulting in unequal access and delays in healthcare (Ndumele et al., 2018).
Secondly, maintaining the efficiency and quality of care delivery is also tricky. For example, not all healthcare providers can meet quality standards, so the person screening this situation should be accessed. Moreover, there might be low reimbursement rates, discouraging healthcare providers from participating in Medicaid-managed programs (Ndumele et al., 2018). In this case, the available healthcare services would be limited.
Recommendations
Several recommendations can be established to increase the efficiency of these plans; the most important ones are cooperation and constant monitoring of the situation. Firstly, the work on expanding the healthcare providers’ networks should be improved. Different initiatives should be created to capture the providers’ attention and encourage them to participate in such programs and plans (Ndumele et al., 2018).
Secondly, the quality metrics should be established so that it would be easier to monitor the systems. In this case, patients would receive highly qualified care and valuable changes in the healthcare delivery system could be made (Ndumele et al., 2018).
Thirdly, there is a need to implement different evaluating strategies to effectively analyze the gathered data and use them to improve healthcare delivery (Greenough & Ku, 2023). In addition, it is necessary to address the reimbursement rates primarily in regions such as rural areas, where these costs are incredibly high. If these rates are fair and competitive, more healthcare providers would be willing to participate in such initiatives.
Conclusion
To conclude, Medicaid-managed plans play a vital role in healthcare delivery, and it is a complex issue that should be analyzed. The primary mission of such plans is to ensure that each individual has equal access to healthcare services, especially among low-income populations. Quality of care, access, and cost remain significant challenges that require proactive measures to address. In this case, the recommendations of cooperation and expanding the healthcare provider network can be implemented.
References
Medicaid Expansion and Health Plan Quality in Medicaid Managed Care. (n.d.). Chapter 7: Medicare Advantage and Medicaid Managed Care
Greenough, S. & Ku, L. (2023). Access & equity in medicaid:Robust primary care is a must. Web.
Ndumele, C. D., Schpero, W. L., & Trivedi, A. N. (2018). Medicaid expansion and health plan quality in Medicaidmanaged care. Health Services Research, 53(Suppl Suppl1), 2821–2838. Web.
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