The total health care spending in the United States is expected to reach $4. 8 trillion in 2021. In other words, by 2021, the health care spending will account for almost 20 percent of the U. S. economy. Following the escalation of costs, the pace of change in health care has also increased dramatically. To keep up with the changes, new approaches to keeping health care costs down, quality up, and access for all are continually being developed. This essay will analyze the similarities and differences of the organizational models stemming from the health care reform.
In particular, the focus will surround defining and describing key features of HMOs, ACOs, and CCOs and their association with mental health coverage. Also a discussion will occur on the purpose of health care reform as it relates to managed care. And finally, an examination on whether or not ACOS and CCOs will change the nature and goals of managed care. Health Maintenance Organization (HMO) in simpler terms is often times explained as “one stop shopping”. The HMO concept is referred to as a “pre- paid health plan” because it combines two functions.
First it provides health coverage to its enrolled members. Secondly, it’s as all-inclusive health care services through a pre-approved network system of providers and health care serve entities. HMOs are financed by fixed recurring payments determined in advance by pledged agreements between the insurance company (the HMO) and the employer contracting to purchase services for their organizations. One of the most prominent examples of HMOs today is Kaiser. There are a few key points that make up an HMO. First, an HMO is a managed care plan in which members are approved a Primary Care
Physicians (PCP). The PCP acts like a gatekeeper for care. Therefore, the PCP facilitates all medical care for the members and provides any referrals to necessary specialists. Next, HMOs focus on prevention and wellness. HMO enrolled members receive wellness and care reminders in the mail. If the enrolled member decides to go for services outside of the approved network, expect for emergencies, the member is responsible for any services charge. Lastly, HMOs generally are customized for Large Groups, whereas products for smaller groups are usually standardized.