Role of Managed Care and Other Models for Reimbursement

Managed care has had a profound impact on the way that health care is delivered and paid for in the United States. A large portion of Healing Hands Hospital’s revenue comes from managed care reimbursement making managed care a very important part of the business process. Part of the Task Forces work will include obtaining feedback from the community and a public relations committee has been formed to help educate the community when decisions are made about changes to Healing Hands Hospital. Mr. Johnson, Healing Hands Chief Financial Officer, has asked you to help provide some training to the members of the public relations committee to help them understand managed care and other possible models for reimbursement including value-based reimbursement and Accountable Care Organizations (ACOs), so this can be included in their campaign of community education. Your report to Mr. Johnson should include: Identify two types of managed care plans, such as Preferred Provider Organizations (PPO) and how they impact the way that health care is delivered at Healing Hands Hospital. Discuss the future of managed care as a viable reimbursement model for Healing Hands Hospital compared to Accountable Care Organization model and valued based reimbursement. Through legislation such as the Patient Protection and Affordable Care Act and MACRA, there are regulations and requirements set by the Centers for Medicare and Medicaid Services that are designed to improve patient quality of care and ensure highest levels of reimbursement. How do these laws impact Healing Hands Hospital and its financial plans? Mr. Johnson, like all healthcare management professionals, believes that the data and information presented must be backed by good research and the reference sources must be listed appropriately in the written report.

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