MANAGED CARE PROVIDERS 7
ManagedCare Providers
ManagedCare Providers
Theneed to ensure delivery of quality and affordable healthcare hasremained a key area of focus to many governments, health institutionsand other stakeholders across the globe. This is based on the factthat, through provision of high quality and affordable healthcare,productivity in various sectors of the economy increasessignificantly. Consequently, this goes a long way in ensuringsustainable development as advocated by major world bodies such asthe United Nations and World Bank among others. For instance, in2010, the US signed ACA (Affordable Care Act), also referred asObamacare into law. The main reason for the enactment of such a lawwas to offer affordable healthcare to all the Americans as well asdesigned to protecting consumers from unscrupulous insurance firmswho increase who intentionally drive up costs of insurance forpersonal benefits. As a result, through ACA, millions of Americanshave been able to receive insurance coverage, majority of them beingthose from low-paying jobs or unemployed (Roland, 2015). However,despite the efforts made by the US government, there is the urgentneed for private insurance and medical institutions to ensure theyhelp the government offer affordable healthcare, as this will ensuremore coverage in the long-run through managed care systems. It isbased on this that, Integrated Independent Physicians Network, LLCand Cigna Inc entered into collaboration on 1stApril, 2016 (Business Wire, 2016). The section below will offer thebackground of the two institutions as well as the impact which thecollaboration will have as far as managed care in the US isconcerned.
Backgroundat Integrated Independent Physicians Network, LLC and Cigna
IntegratedIndependent Physicians Network is an IPA (Independent PhysicianAssociation) based on Orlando representing at least 1300multi-specialty physicians from seven counties in Florida. Thenetwork is able to offer a system of healthcare which is centered onancillary and independent physicians’ providers (Business Wire,2016).There is also the inclusion of CAN (Clinical AllianceNetwork), which is a state wide specialty pediatric network ofphysicians in Florida.As a result of this, the IP network hasbecome a high quality and cost-conscious, thus being able offerimproved healthcare which is value-based. Some of the servicesoffered by IP network include outpatient labs, clinical research anddiagnostic facilities among others.
Onthe other hand, Cigna Corporation is a health service company,offering it services across the globe. The company is fullydedicated in ensuring people improve their well-being, health as wellas sense of security. It is notable that, the company operatessubsidiaries such as Cigna Health and Life Insurance Company, thusbeing able to help the company offer services and productseffectively to the customers. Some of the integrated suite ofservices and products offered include disability and accidentinsurance among others. As a result of high quality services andproducts offered, the firm has undergone massive expansion andcurrently operates in 30 countries with more than 90 millioncustomers globally (Business Wire, 2016).
Importanceof Managed Care
Oneof the main things which clearly come out of this article is theimportance of managed and collaborative care towards the improvementof the US healthcare system. First, it is worth noting that, managedcare plans are special types of health insurance, aimed at managingcost while ensuring provision of quality at all levels. Theinsurances have contracts with medical facilities and healthcareproviders where members’ are able to receive medical services atreduced costs. It is worth noting that, the health insurances arethe ones who have the mandates of designing and developing theservices and products which are enjoyed by the members. One of theoldest managed care plans which exists in the US is the HealthMaintenance Organizations. In this particular plan, members areoffered various health benefits, and pay a small fee once the serviceis rendered. In order to ensure efficiency of this program membersare required to select a particular Primary Care Physician, who isresponsible in offering care. The other managed plan is PPO(Preferred Provider Organizations). In this plan which is offered byprivate companies, members usually pay less once they receiveservices within the network offered by their insurance policies.Point of Service (POS) is also another plan which allows members tomake a selection between PPO and HMO every time they seek for medicalcare. Besides the managed care plans, there exists collaborativecare where by several healthcare providers together with communitiesand caregivers in order to ensure provision of high quality care(Medicaid.gov , 2016).
Impactof the Collaboration on Managed Care Systems
Itis clear that the collaboration between Integrated IndependentPhysicians Network, LLC and Cigna Inc will go a long way in improvingthe delivery of healthcare in the US. As indicated on the article,the collaborative care offered by Cigna is value-based model aimed atenhancing care coordination, ensure affordability as well as patienceexperiences.In the areas where similar programs have beenintroduced by Cigna Inc, they have helped to raise the number ofpreventive health care visits, improve follow-up to people whotransition from home to hospital among other notable benefits. Through this collaboration, care coordinators will be aligned to theteam of case managers from Cigna, thus ensuring better experience forall individuals. As indicated by Dr. George White, the CEO of CignaInc., when health insurers and physicians work as a team, there isreal improvement in healthcare. By transitioning to a reimbursementmodel that is value based, it become possible to reward doctors andother practitioners for results, thus enabling them to focus more onother issues such as prevention and care coordination. Based onthis, Cigna will offer compensation to the IP Network for carecoordination and medical services offered. In addition to this, “payfor value” structures developed by Cigna Inc can also be employed.This will encourage Independent Physicians Network to meet the settarget as far as lowering medical cost and improving quality isconcerned.
PossibleChallenges and Recommendations
Thereare many challenges which Cigna will face in its collaborative carearrangements with IP Network. One of the major issues is that whichpertains to value-gap. It is notable that, majority of consumers inthe US who make use of private insurance posses mixed feelings aboutthe exact value of the services and products offered. This is basedon the fact that majority of the consumers have little knowledge ofthe policies and the exact coverage of the policies bought. As aresult, there has been laxity to acquire new policies to majority ofthose who do not have access to insurance policies. To deal withthis issue, it is important for Cigna to conduct civic educationacross the concerned areas, in order to create awareness as well asminimize the existing misconception as far as value-gap is concerned.
Theother major challenge facing Cigna is competition from other privateand public healthcare insurances which offers managed care services.One of the notable competitors is the Obamacare healthcare programthat normally targets the lower-class citizens who normally find ithard to get insured by private firms. Therefore, as Cigna attempts toperfect its “triple aim”, quality, affordability and satisfactionmandates through collaboration with other parties, the organizationmay be forced to reduce the cost of the insurance, a factor which maysignificantly affect delivery of quality services (Dolan, 2013). Tocounter this issue, the firm can diversify its products and servicesportfolio, thus ensuring that they have competitive advantage in themarket both in the short and long-run.
Conclusion
Inconclusion, it is notable that managed care plays a critical roletowards provision of quality health care in the US. This is due tothe fact that, organizations mandates to offer such services help tosupplement and in some instances complement what the government offers to the healthcare services such as through the Obamacareprogram. Therefore, the collaboration between IP Network and CignaInc will go a long way in improving the delivery of healthcare in theUS. Further, Cigna will be able to offer compensation to the IPNetwork for care coordination and medical services offered. One ofthe challenges which will face such collaboration pertains tovalue-gap. . To deal with this challenge it is crucial for Cigna toconduct civic education across the areas where the firm conductsbusiness. Other challenges include competition from private insurancecompanies among others.
References
BusinessWire(2016). Cignaand Integrated Independent Physicians Network, LLC Collaborate toImprove Health and Lower Costs in Florida.Available at http://www.businesswire.com/news/home/20160516005884/en/
Dolan,B. (2013). UnderstandingCigna`s evolving digital health strategy.Available athttp://mobihealthnews.com/22507/understanding-cignas-evolving-digital-health-strategy
Roland,J. (2015). ThePros and Cons of Obamacare.Available at http://www.healthline.com/health/consumer-healthcare-guide/pros-and-cons-obamacare#Overview1
Medicaid.gov(2016). Managed Care. Available athttps://www.medicaid.gov/medicaid-chip-program-information/by-topics/delivery-systems/managed-care/managed-care-site.html