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Related Concept Videos

Methods Of Healthcare Delivery System01:26

Methods Of Healthcare Delivery System

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At the different levels of the healthcare system, we see varying methods of healthcare used. These methods include managed care systems, case management, and primary healthcare.
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is...
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Secondary Healthcare System01:11

Secondary Healthcare System

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Secondary healthcare is offered by a specialist, generally in hospitals or clinics for patients referred by primary healthcare providers. It occurs when a person has an illness or injury that requires specific medical care. Secondary care is often referred to as acute care. Secondary care can range from uncomplicated care to repair a minor laceration or treat a strep throat infection to more complicated emergent care, such as treating a head injury sustained in an automobile accident. Whatever...
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Methods of Documentation VI: Case Management Model01:15

Methods of Documentation VI: Case Management Model

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The case management model is a multidisciplinary approach that involves healthcare professionals from diverse disciplines, such as physicians, nurses, therapists, social workers, and pharmacists, working collaboratively to address the various needs of patients. Each healthcare professional brings unique expertise and perspectives, contributing to a more comprehensive understanding of the patient's condition and tailoring treatment plans accordingly.
For example, a patient with a chronic...
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Integrated Healthcare System01:20

Integrated Healthcare System

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An integrated healthcare system (IHS) is a set of organizations that provides for or arranges to provide coordinated and continuous service to a defined population. The IHS takes responsibility for that particular population's health status and outcome, both clinically and fiscally. An integrated healthcare system is a well-organized, well-coordinated, and collaborative network. The integrated delivery system is a network that connects different healthcare providers to deliver organized,...
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Traditional Level Of Health Care System01:26

Traditional Level Of Health Care System

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The levels of care describe the services provided in the healthcare system. Accordingly, there are six levels of the traditional healthcare system in the US: preventive, primary, secondary, tertiary, restorative, and continuing healthcare. A nurse must understand how the healthcare industry organizes and provides services within these levels of care.
The preventive healthcare service includes tests for screening. Preventive health care services include identifying and reducing disease risk...
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Specialized Care Centers and Settings-II01:30

Specialized Care Centers and Settings-II

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Rural Health Centers
Rural health centers are specialized care facilities in remote locations with very few medical personnel. The primary care providers who run the centers are mostly Registered Nurse Practitioners. Here, emergency treatment is provided to critically ill or injured patients before they are transferred to the closest hospital. Fortunately, due to advancement in technology, many rural healthcare facilities and professionals have easy access to diagnostic and treatment...
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Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform
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Managed care: the second generation.

F R Curtiss1

  • 1Reimbursement Update, Inc., Double Oak, TX 75067.

American Journal of Hospital Pharmacy
|September 1, 1990
PubMed
Summary
This summary is machine-generated.

Managed health care, now in its second generation, is reshaping healthcare delivery with new trends like risk-sharing plans and direct contracting. This evolution drives price sensitivity and impacts hospital and pharmacy operations.

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Area of Science:

  • Healthcare Management
  • Health Economics
  • Health Services Research

Background:

  • Managed health care evolved significantly in the 1980s into a three-segment industry: health maintenance organizations (HMOs), preferred-provider organizations, and fee-for-service plans.
  • As a mature component of the U.S. healthcare system, managed care is entering its second generation, marked by emerging trends.

Purpose of the Study:

  • To describe the current status of managed health care.
  • To summarize the impact of managed care on hospital and pharmacy operations.

Main Methods:

  • Analysis of the evolution and current trends in managed care.
  • Examination of cost-management methods in contract negotiation (benefit design, provider reimbursement, prospective pricing).
  • Assessment of the impact on healthcare consumers, hospitals, and pharmacies.

Main Results:

  • Emerging trends include dual/triple-option plans, point-of-service benefit determination, consolidation of health plan options, exclusive provider organizations, and direct provider contracting.
  • Managed care significantly influences hospital reimbursement and utilization review.
  • Pharmacy operations are variably affected, with potential for enhanced appreciation of clinical pharmacy's role in reducing readmissions and hospital stays.

Conclusions:

  • Managed care fosters greater price sensitivity among consumers, leading to reduced unnecessary healthcare utilization.
  • Patients face trade-offs between provider choice and out-of-pocket costs.
  • The ongoing evolution of managed care necessitates adaptation in healthcare delivery and operations.