The actuarial cost models for behavioral health care include Medicare and Medicaid providing patients with residential treatment programs. As a rule, the managed care is referred to as a scope of techniques and services delivered by managed care organizations to patients. Residential treatment programs exist within Medicare and Medicaid health care providers (Melek, 2001, pp. 34-35). The effective residential treatment is a result of sufficient organizational measures taken by medical care organizations in order to deliver the most appropriate health care services to the patients without a risk of reimbursement or other risks existing in the health care sector. As suggested by Melek (2001), the modern situation in the medical care environment:
Today, different approaches to provider reimbursement have changed the nature of risk for the carriers and behavioral health care providers. Managed behavioral health care contracts now have provisions that shift risk to providers through guaranteed discounts off billed charges, per diem rates, per case rates, modified case rates, capitation payments, and risk pools and withholds (p. 30).
Thus, the managed care environment is able to support the services required to provide effective residential treatment as it now has been included into the package of health care services provided by existing providers.
As the Medicaid is considered to be a more available type of health care organization providing different types of treatment to different categories of population, people are able to get reimbursement regarding the Medicaid (Department of Health & Human Services, 2010). Another health care provider, Medicare is involved into reimbursement as well, though the doctors and other health care providers are refusing to deal with Medicare patients because of the high reimbursement rates which can cause shutting off medical practises (Kavilanz, 2010). Consequently, the publicity available information on Medicare and Medicaid enables patients to choose whether trust their health to one of these health care organizations or trust none of those.
As you can see, the managed care environment is able to support services that seem to be profitable for medical care providers, such as doctors and practitioners. The Medicare and Medicaid services are the ones that are not desired by doctors: patients involved into these services are under the risk of receiving poor or inadequate treatment as a result of practitioners not willing to suffer losses because of the high reimbursement rates. As residential treatment includes staying at hospital for a certain period of time, it should consider some residential treatment facilities. Residential treatment facilities and acute inpatient settings are the ones that “hospitals and facilities are reimbursed an agreed-upon dollar amount for each patient bed-day” (Melek, 2001, p. 30) which makes the residential patients disadvantageous cases for health care providers. Medicare and Medicaid are insurance carriers whereas health care establishments and doctors within those are health care providers. In this respect, the health care services get reimbursement for each residential patient receiving health care treatment every day, whereas health care providers are not interested in giving the reimbursement to the companies that are known to have a high reimbursement rate.
Residential treatment is one of the facilities that is fulfilled in the form of an agreement between the health care services and health care providers. One part is concerned about the reducing the health care treatment costs, whereas the other part is not eager to receive only the flat payment for services delivered.
Reference List
- Department of Health & Human Services. (2010). Medicaid reimbursement & finance.
- Kavilanz, P. (2010). Doctors threaten Medicare backlash. CNNMoney.com. Web.
- Melek, S. P. (2001). Forms of payment, capitation, and risk management. In E. C. Ross (Ed.), Managed behavioral health care handbook (pp. 29-56). Gaithersburg, Maryland: Jones & Bartlett Learning.