There are many kinds of managed care plansan alphabet soupfor example, with PSOs, PPOs, and HMOs the most prominent. Managed care plans use a number of techniques. Some of them are directed at physician behavior. Others are directed at subscribers to the plan.
- What do you believe to be the major obstacle to access in managed care? Be sure to provide support for your position.
- Discuss some of the ethical concerns and what you would do about the ones you discussed.
REQUIREMENTS: 1 PAGE, APA FORMAT
Required Readings
Blumenthal, D., Chernof, B., Fulmer, T., Lumpkin, J., & Selberg, J. (2016). Caring for high-need, high-cost patientsan urgent priority. New England Journal of Medicine, 375(10), 909-911.
Bridger, C. M., Smith, S. E., & Saunders, S. T. (2017). Saving lives and saving money: The role of North Carolina health departments in Medicaid managed care. North Carolina Medical Journal, 78(1), 55-57.
Cleverley, W. O., & Cleverley, J. O. (2017). Essentials of health care finance. Jones & Bartlett Learning.
Hines, A. L., Raetzman, S. O., Barrett, M. L., Moy, E., & Andrews, R. M. (2017). Managed care and inpatient mortality in adults: Effect of primary payer. BMC Health Services Research, 17 doi:10.1186/s12913-017-2062-1
Keast, S. L., Skrepnek, G., & Nesser, N. (2016). State Medicaid programs bring managed care tenets to fee for service. Journal of Managed Care & Specialty Pharmacy, 22(2), 145-148.
Mahmoudi, E., Tarraf, W., Maroukis, B. L., & Levy, H. G. (2016). Does Medicare managed care reduce racial/ethnic disparities in diabetes preventive care and healthcare expenditures? The American Journal of Managed Care, 22(10), E360.
McGinnis, T., Houston, R. & Brown, D. (2013) The balancing act: Integrating Medicaid accountable care organizations into a managed care environment. Center for Health Care Strategies: Issue Brief. Retrieved from:
Richard, D. (2017). What is next for behavioral health in managed care? North Carolina Medical Journal,78(1), 30-32. doi:10.18043/ncm.78.1.30.
Schafer, J., Galante, D., & Shafrin, J. (2017). Value tools in managed care decision making: Current hurdles and future opportunities. Journal of Managed Care & Specialty Pharmacy.
Thompson, B. & Robbins, A. (n.d.) Understanding managed care. Washington State DSHS. Retrieved from:
Uriarte, J. (2015, August 10). 6 Dimensions of Healthcare Quality [Video file]. Retrieved from
Walters, T., Parcher, B., Kravetz, A., Campbell, C., Shah, M., & Hale, T. (2016). Appraising the value of digital health technologies from the managed care perspective: Insights for evidence assessment and reimbursement in the United States. Journal of Medical Internet Research, 18(12).
Wang, Tze-Fang; Shi, Leiyu; Nie, Xiaoyu; Zhu, Jinsheng. (2013). Race/ethnicity, insurance, income and access to care: The influence of health status. International Journal for Equity in Health, 12(1), p.29
