The Spillover Effects of Medicare Managed Care, Case Study Example

Introduction

The current model employed by the federally sponsored Medicare system represents a number of significant challenges that require continuous evaluation and change in order to address improved efficiency and cost effectiveness for all patients. A managed care model of delivery would shift the direction of care and treatment towards this premise, given the options that may be available to improve quality of care when efficiency is optimized. Therefore, it is necessary to identify new methods of addressing the health and wellbeing of patients through the development of a framework that supports effective patient care and treatment on a continuous basis. An evaluation of Medicare Advantage (Part C) must be conducted in order to determine its level of success and its ability to meet the required objectives in reducing the cost of services for patients (Baicker, Chernew, & Robbins, 2013).

Body

Medicare Advantage is utilized by 27 percent of its enrolled population, thereby increasing the potential that this system will have a lasting impact on the entire Medicare system as a whole (Baicker et.al, 2013). Most importantly, the spillover effect of this alternative has demonstrated its value in that the costs associated with hospitalizations have been reduced and there are reduced lengths of stay for many patients (Baicker et.al, 2013). This is an important reminder of the potential value of a larger managed care framework that extends beyond Advantage/Part C that will have a lasting impact on patient care outcomes for the foreseeable future (Baicker et.al, 2013).

It is also important to provide elderly patients with additional Medicare options to address their healthcare needs, given the tools and resources that are required to ensure that patients receive optimal care and treatment with the intent to reduce hospitalizations and overall costs (Mittler, Landon, Zaslavsky, & Cleary, 2011). In this capacity, the number of options available to patients must coincide with the ability to expand awareness of the Part C option to encourage patients to consider this alternative (Mittler et.al, 2011). Medicare beneficiaries must be able to consider the role of managed care plans in their overall strategy and to evaluate their options with respect to their own level of risk and the potential need for increased services and hospitalization in some cases (Mittler et.al, 2011). Patients who rely on Medicare as their primary form of insurance must be provided with as many options as possible and the information that is necessary to make informed decisions regarding their healthcare. The options that are available through Medicare Part C support these objectives and provide a framework to encourage patients to seek care and treatment in a timely manner to reduce costs and to promote effective utilization of services at the desired level. Patients will benefit from these tools as they receive an appropriate level of care and treatment from their healthcare providers and also encourage patients to be successful in their ability to receive high quality care and treatment on a necessary basis.

The role of Medicare Advantage cannot be undermined, as it has been largely instrumental in reducing the costs associated with utilization rates for outpatient services and for professional needs, thereby demonstrating the impact of this plan and the benefits of adopting a managed care structure (Marton, Yelowitz, & Talbert, 2014). Furthermore, available resources are likely to be effectively utilized through a framework that supports effective patient outcomes and the value of cost containment as part of the process to facilitate effective results for patients (Marton et.al, 2014). Therefore, additional measures to support a managed care approach to Medicare must be identified in order to demonstrate its value in reducing costs and in promoting efficiency and effective outcomes for patients (Marton et.al, 2014).  Patients will benefit from this practice when they receive the type of care and treatment that is designed to promote recovery and have been effective in addressing their needs in a comprehensive manner. At the same time, it is likely that organizations who accept Medicare Part B and its primary strategy will reap the benefits of this alternative through the choices that are made regarding the provision of care and treatment for patients. A managed care alternative appears to be a feasible and practical approach to better manage the needs of older patients and to ensure that cost optimization is achieved as best as possible. This also provides an opportunity for healthcare providers to examine their current structures and to be proactive in meeting the needs of their patients through extensive outreach and communication with their patients to ensure that they understand the structure and how it might benefit their healthcare needs.

Conclusion

The expansion of Medicare Part C/Advantage with a managed care component is likely to provide further evidence that this model will have a lasting impact on patient health and wellbeing, both now and in the future. The costs of this program have demonstrated a lasting impact on patient care and on utilization rates, thereby decreasing the number of hospitalizations required and the costs related to outpatient services for many patients (Baicker et.al, 2013). Therefore, this strategy must be effectively utilized in order to address the challenges of Medicare expansion and the ever-increasing cost of these services for the consumer population. It is important to identify the different scenarios under which Medicare Part C/Advantage might be more effective with increased exposure and attention to improve cost effectiveness and overall efficiency to achieve the intended results in the context of improved quality of care in a cost effective manner.

References

Baicker, K., Chernew, M. E., & Robbins, J. A. (2013). The spillover effects of Medicare managed care: Medicare Advantage and hospital utilization. Journal of health economics, 32(6), 1289-1300.

Marton, J., Yelowitz, A., & Talbert, J. C. (2014). A tale of two cities? The heterogeneous impact of medicaid managed care. Journal of health economics, 36, 47-68.

Mittler, J. N., Landon, B. E., Zaslavsky, A. M., & Cleary, P. D. (2011). Market characteristics and awareness of managed care options among elderly beneficiaries enrolled in traditional Medicare. Medicare & medicaid research review, 1(3).