Discuss Managed Care
Discuss managed care, the initiatives implemented by private insurers to transform healthcare, and the various roles nurses play to improve quality patient outcomes tied to healthcare reimbursement. What are some strategies nurses can use to advocate for healthcare consumers and reduce the increasing cost of healthcare?
APA format initial discussion: 400 words and make up 2 replies to 2 students with 200 words each
Sample Paper
Discuss managed care
If you have a health plan, you almost certainly have a managed care plan. The term “managed care” refers to a type of health-care delivery that prioritizes cost-cutting while maintaining high levels of care.
Today’s most popular health plans usually contain managed care. Among these are provider networks, provider monitoring, prescription medication tiers, and other issues. These are designed to keep everyone’s costs down while still providing high-quality care.
The Initiatives Implemented by Private Insurers to Transform Healthcare
The Patient Protection and Affordable Care Act’s multidimensional approach to addressing the country’s long-standing uninsured problem involved restructuring the individual health insurance market, including the creation of health insurance exchanges. Despite having enrolled millions of Americans, the exchanges have a number of challenges, including a poor consumer experience, high operating and development costs, and a lack of market penetration.
In light of these concerns, experts looked into a different exchange model—privately facilitated exchanges—that could address these concerns while also increasing the Affordable Care Act’s reach. In this paradigm, the government retains sovereignty over sovereign exchange operations while outsourcing more peripheral exchange activities to the private sector, such as the creation and maintenance of exchange websites. Commercially facilitated exchanges might theoretically relieve the government of complete responsibility for front-end website operations and consumer decision-support tasks, despite the fact that private-sector enterprises have already taken on limited exchange-related obligations.
A shift to privately run exchanges might improve customer service, increase membership, and save money for state and federal governments. Moving to this paradigm, however, raises worries about lower consumer protection, increased consumer confusion, and the likelihood of a lack of a viable revenue base for privately assisted exchanges, especially in less populous areas. Overall, the benefits are great enough, and the risks are manageable enough, that such a move should be seriously considered. This page provides background information as well as more insights on the conclusions of the analysts.
The Various Roles Nurses Play to Improve Quality Patient Outcomes Tied to Healthcare Reimbursements
It takes a little more effort to provide cost-conscious care, but the rewards can be substantial.
Nurses aren’t just about providing care at the bedside. Many nurses are innovative thinkers who come up with new ways to improve the places in which they operate. In fact, several nursing programs include leadership and management courses that introduce the concept of healthcare budgeting and pricing.
Nurses have a significant impact on healthcare costs since they work on the front lines. Without information and feedback from front-line employees, change from the top does not work. Many department heads conduct improvement programs with the help of front-line employees, such as receptionists, nurse’s aides, and registered nurses. Nurses, for example, can go around to see which supplies are superfluous and have been sitting around for a long time, and possibly remove particular items from stock.
Strategies Nurses can Use to Advocate for Healthcare Consumers and Reduce the Increasing Cost of Healthcare
The primary concern of the nursing profession is to provide high-quality patient care. Although nurses are crucial to cost-conscious treatment, many nurses are unaware of their relevance to their healthcare organization’s bottom line. Nurses, for example, make up the bulk of healthcare personnel in hospitals and other healthcare settings, therefore their salaries make up a large percentage of the budget.
Healthcare organizations must be cost-conscious and look for creative ways to save expenses without sacrificing patient care. Hospitals that find cost-cutting opportunities are more financially stable and, as a result, more financially solvent. Because of their financial stability, they can continue to deliver high-quality services and nursing care to patients.
WHAT ARE THE EFFECTS OF COST SAVINGS ON PATIENT CARE?
Healthcare businesses must be cautious when it comes to saving money. Cost-cutting measures can have a substantial impact on the quality of patient treatment. Cutting expenses in a deliberate approach, on the other hand, does not have to imply sacrificing the quality of care delivered to patients. It’s critical to know which costs to cut and how to cut them, as well as which costs not to cut.
EFFECTS OF PROVIDING QUALITY WHILE SAVING MONEY ATTENTION TO PATIENTS
It is entirely possible to save money and provide cost-conscious care in the clinical setting without compromising nurse care. Here are a few instances of how nurses can help with the process:
Producing, transporting, and storing information such as health records in an electronic format.
Assisting nursing departments in sticking to their budgets.
Reduction of waste.
Creating sufficient employee schedules to eliminate the need for overtime.
Employee benefits that are less costly are in demand.
