Manage Managed Care And Reimbursement Challenges

Concerns about cost have led to the popularity of managed care options, first by corporations for their employees and now by governments, through the Medicare and Medicaid programs. Despite recent federal budget surpluses and proposals to expand funding and benefits in Medicare, there is serious concern among economists, legislators, and bureaucrats about the long-term solvency of both publicly funded programs.
Concerns about cost are present in every form of nursing practice; they affect how work is organized, treatment plans for patients, and patients' perceptions of and participation in care. For example, even individuals with health insurance are wary of increased out-of-pocket expenses and no covered services. And there is heightened concern about pharmaceutical costs, fueled, in part, by the development of sophisticated new drugs. …show more content…
Despite the promise for flexible financing that managed care risk was thought to offer, provider contracts are still based on fees for service, reducing the incentives to truly manage care, prevent illness, and promote health. Nursing professionals, who have historically taken the lead in health education and health promotion, are disappointed by the lack of financing and reimbursement available through managed care organizations for these vital services. However, advanced practice nurses - nurse practitioners and case managers in particular - have benefited greatly by the managed care movement. Demand for these lower cost providers has dramatically increased, and their competence and quality in the primary care field have been