I need a response to this discussion: Given the majority of us have health insurance, its pre-determined that were have a managed care plan. According to The Institute of Medicine (2018), managed care is a type of health care that attempts to decrease costs while still offering high-quality service. In today’s most popular health plans, managed care components are prevalent. Prescription medicine tiers, prescription drug networks, and provider monitoring are only a few of them. These are designed to keep healthcare costs low while maintaining excellent quality for everyone. This is a health maintenance organization (HMO), which is a great example of a managed care arrangement (Health Maintenance Organization). Your medical care is closely monitored by HMOs. A health maintenance organization (HMO) is less expensive than a typical insurance plan. Only a small number of local service suppliers are visible, which helps keep costs down. A Primary Care Provider must oversee all of your medical care (PCP). Other well-known health plans are also featured in this category. The private health insurance plan industry has led the way in implementing methods to increase the value of health care by utilizing medical evidence to enhance both quality and cost. The main method private health insurers are changing healthcare is via evidence based research. Private insurers are exploring methods to minimize wasted money, in order to decrease rates and improve quality (Levitt, 2019). One of these evidence-based methods is the use of pharmacy management to examine the scientific evidence on what works and evaluate the available cost and comparative effectiveness data to determine which medicines should be placed on formularies. Another is the use of pharmacy management to evaluate the available cost and comparative effectiveness data to determine which medicines should be placed on formularies. Usage management is another way the private insurer is influencing healthcare. These approaches evaluated proposed therapies to evidence-based recommendations in order to minimize needless differences in practice and identify therapy that was inappropriate or unsupported by medical evidence. Nurses are responsible for more than simply providing bedside care. Many nurses are innovative and come up with novel ways to enhance their working circumstances. In reality, many nursing schools include leadership and management courses that address healthcare pricing and budgeting. Because nurses are on the front lines, they have a significant influence on healthcare costs. Without involvement and feedback from front-line workers, top-down leadership changes are ineffective. According to The Institute of Medicine (2018), many department heads seek the assistance of front-line workers, such as receptionists, nurse’s aides, and registered nurses, to carry out reform initiatives. For example, nurses may circle to determine which goods are superfluous and maybe go unused for extended periods of time, and perhaps even remove specific supplies from stock. Another way nurses may influence organizational costs is to argue against unnecessary treatments or prescriptions. Nurses, for example, may assist doctors in making better treatment choices by carefully recording and reporting symptoms and patient progress. Nurses may assess discomfort and offer to hold a dosage to see how the patient tolerates it if a post-op patient is taking pain medications around the clock, for example. The physician may transition to PRN if the pain is managed without the need for round-the-clock medication, reducing expenses. Levitt, L. (2019). Whats The Role of Private Health Insurance Today and Under Medicare-for-all and Other Public Option Proposals? KFF. Institute of Medicine (US) Roundtable on Evidence-Based Medicine. Leadership Commitments to Improve Value in Healthcare: Finding Common Ground: Workshop Summary. Washington (DC): National Academies Press (US); 2018. 11, Insurers.
