AHA 209 — Philosophy of Managed Care
Managed care is now mainstreamed in America's healthcare system and has changed the delivery of healthcare services. Individuals working in the healthcare arena need to understand the impact of managed care on patients and providers. This course will review the evolution of managed care, explore how it works, contemplate its future and discuss the ethical issues surrounding it today. The roles and responsibilities of the case manager will be investigated as well. The topic of Utilization Review will also be introduced in this course. It is essential for healthcare facilities to be able to control and manage the use of their services to minimize the risk of financial loss. Utilization Review monitors and provides appropriate incentives to influence the use of healthcare services. Managed care and Utilization Review are tools to coordinate and measure the delivery of cost effective quality care and have the potential to achieve significant containment of healthcare costs, an essential outcome in our present health care system.