The Healthcare Industry

The Healthcare industry is constantly evolving. It is usually evolving to a more cost conscious direction. With Managed Care it is important to know that it comes in many different varieties. Traditionally, managed care progressed in the United States to impact the use of medical care by improving results and productivity. The earlier three decades of experience with this method implies that minimally some of these ideas have been comprehended. Eight managed care-contracting terms that are imperative to growth and opportunity in the medical field are the Medical Services provided. Medical services must balance the enclosed services under the contractual agreement. According to Managed Care contracting, "If a plan chooses or is required by the state to add benefits, they typically give a physician 90 days written notice. A physician has the right to terminate if he or she cannot or will not agree to perform the service. "(Rosenberg) Locations and services is another important managed care contracting term because having the proper service is a necessity and in a popular location is important for consistence with patients. Medical Records requires that physicians uphold and retain medical records is standard medical practice. Liability coverage is another managed care must have. Health care providers must deliver certification of liability coverage, incorporating inclusive general and professional liability, and workers' compensation coverage, in amounts accustomed for the state and as required by the Plan. "Any coverage changes must be provided to the Plan in writing 15 -30 days in advance of the change. The provider is also responsible for notifying the MCO of any potential member claim that may arise." (Rosenberg) Rosenberg stated that there is a contract review checklist that is useful when researching and double-checking managed care services. He states that having an updated list of primary physicians is a must have, along with understanding the referral authorization procedures to ensure all goes smoothly. Lastly, "Request a copy of all policy and procedure manuals specified in the contract." (Rosenberg)

Within the last 10 years there has been a huge change in managed care. Those managed care plans that survived the last tumultuous decade face new battles. As we put it in a look back at the '90s in our November 1999 issue, "The rise of HMOs to a position of overwhelming influence on the delivery of care surprised a lot of patients and physicians, and lately the increasingly successful counterattack of the 'un-managers' who brought us point-of-service plans, mandated minimum hospital stays and, now, a patients' bill of rights, has become a thorn in the side of health plans that pretty much had carte blanche."(Aspling) The quote that I had just posted was a glimpse of how managed care was received in the 90's now the system has come a long way to improve