Question

What do you think people are looking for when choosing a managed healthcare plan? Explain.

Answer 1

Managed Healthcare Plan

Introduction

The term managed healthcare refers to a group of activities intended towards reducing the medical cost and providing American health insurance. This plan is basically to reduce the high cost of the healthcare system through a number of mechanisms, which are like economic incentives for the health professional and clients select less costly forms of care.

Benefits of a managed healthcare plan

• It lowers health care costs.
• People get a better information management system
• Patients are guaranteed for a specific level of care
• Better drug cost
• As they have a billing system within their network it becomes easy for the clients to manage the paperwork.
• Patients can seek out for care from within their own network

Demerits

• The policies and rules may be rigid
• Busy schedules and long waiting lines
• Lack of privacy
• Limits the access of the individuals who do not have an insurance plan

Types

There are mainly three main types of managed healthcare plan

1. Health Maintenance Organization (HMO)
2. Preferred provider Organization (PPO)
3. Point of Service insurance Plan (POS)

Choosing a managed healthcare plan

When people are selecting a managed healthcare plan they often look for the following aspects:

Benefits and the services provided

• People usually look for a comprehensive package plan that covers preventive health care as well as the treatment for chronic ailments.
• Also, people want that if the client is admitted for a short duration of time then will the hospital cover the post-discharge care.
• They would also look into the services which are covered by the managed healthcare plan, for example, immunization of child, screening for breast cancer, cervical cancer, etc
• They would also check whether emergency care is also included in the service plan

Cost versus the Benefits

• Clients will also check that how much amount of money they will have to invest outside the plan, and if they turn out to be high then they may look for some plan that has got a less out of the pocket expense.
• They will also be looking for the plans that provides the best possible services and care at the most affordable cost.
• The term period of a managed health care plan also plays a vital role. Majority of the clients prefer to have a highlifetime plan.

Benefits of the prescription drugs

• As the managed healthcare plans only cover the generic drugs; the clients always check-in prior whether the drug that they are using has a generic alternative, or else they may have to pay the full cost of the drug
• Several health care plans have implemented a “Preferred drug list” for a specific diagnosis. The client before opting for a health plan also look whether their drug is present in the preferred drug list.

Quality of care

• Clients would always prefer to have the best quality of care being covered in their managed healthcare plan.
• Clients also check whether the health care plan organization having the accreditation status
• Services provided by the primary health care physician

• Clients would be anxious to know whether their plan allows them to have more than one primary care physician
• The client would also look at whether they can change their primary care physician if they are dissatisfied with them
• Clients suffering from specific health conditions like asthma, coronary heart disease etc may look for specialized primary care physicians.

The network of the health care provider and the geographical areas

• Clients would always look for the healthcare plans that cover their geographical area.
• People also inquire which providers are included in their network and also the providers location within the clients’ community.

Conclusion

Whenever selecting a managed healthcare plan, it is important for the client to critically review and evaluate the choice of the plan available. Managed healthcare plans have a lower cost and less financial risk as compared to traditional insurance ;therefore it is beneficial for the clients to select the best suitable options available among the several health care plan.