Hcs 235 Week Health Care Utilization Paper

wellness t turn backing use base HCS/235 Health Care Delivery in the U. S. Health Care rejuvenate The Patient guard and Affordable Care Act of 2010 (PPACA) was designed to descend wellness cathexis prices and require health financial aid entrance fee to all U. S. citizens. The Act has the potential for reducing the speak to of health carry on in the United States however, with many risks which could possibly strain the health fretfulness system, gain debt, and decrease the quality of get by many are concerned. doorway to Care The PPACA was en bited in 2010 however, the Act was not completely implemented mightily away.The health care reform has been dispersing comestible as the years progressed. furnish such as simply investing in new resources to passage of arms against fraud, waste, and abuse in government sponsored programs such as Medicare and Medicaid volition gird the quality of the programs and also protect taxpayers money. Under the Affordable Care A ctyoung adults are allowed to continue in their parents health amends formulates until they reach twenty six years of age, unless the young adult has health care indemnification under their own employer.In the past, aesculapian health indemnification companies have denied payments for patients who got sick. Incidents where breast give the sackcer patients were found to have lost medical coverage from their indemnification companies after diagnosed with the major disease. The Act makes this action embezzled for policy companies to rescind medical benefits. The purpose of the PPACA is to generate health care run to all Americans, whether through government programs or employeroffered health insurance plans. The Act provides small stemmaes and some large businesses with tax credits for providing health care benefits to their employees.Huge investments are placed into prevention. Preventing diseases and illnesses with free stop care to individuals depart impact the costs o f emergency room claims from individuals who wait until their diseases or ailment is unbearable. Emergency room claims are far more(prenominal) expensive than preventative care. Keeping previously uninsurable individuals healthy before they join Medicare reduces the cost burdens of taxpayer dollars for uninsured patients receiving care at hospitals which go unpaid and drive the cost of health care. UtilizationUtilization management has taken a key role in the health reform act because it evaluates the get hold of, appropriateness, and the efficiency of the health care services which will be used by the covered individual. Health insurance plans are pressured to find ways to reduce plan costs and better the quality of care provided to their members. Utilization management efforts have reduced opposed services and high medical costs just by fetching some time to review pre-authorizations instead of providing clinically inappropriate, out-of-network services which prevents the accurate care for patient and increases cost for plans.Todays decision-making and support of utilizations for members are performed in real-time. Real-time utilization achieves the decrease of unnecessary expenses and improves members health. engage of unnecessary services increases the cost for plans and limits them on the amount of services they can provide to members who are in dire need of them. Universal Health Care Achieving the death of providing health care benefits for all U. S. citizens is a goal that is not new in our health care system and placid lingers to be resolved by government officials.The health reform acts provisions are stated to achieve these goals. The Medicaid involution could possibly insure 21. 3 million Americans however, States are given the opportunity to opt-out of the health reform Medicaid expansion. States will not be penalized for not expanding coverage to low-income individuals or families. The Medicaid expansion will provide services to low- income adults with or without dependent children, low-income children who repeal nineteen years of age and classified as adults, and low-income adults with disabilities who do not qualify for Social Security Benefits.Previous States who have expended Medicaid benefits to their low-income residents have reported a decrease in uninsured residents, improved access to health care, and an increase in a healthy population. The result of States opting out of Medicaid expansion benefits will increase emergency uncompensated care for hospitals and other health care entities. The health reform act will be less hard-hitting and will drive the cost of care for the rest of the country when States opt-out of the Medicaid expansion efforts creating an imbalance within the nation. Personal ExperienceThe Medicaid expansion efforts have provided strict regulations to managed care organizations such as the one I currently work for. However, the provisions for increasing Medicaid expansion in the sta te of Florida will allow more residents to acquire health care benefits which eventually will improve the overall health of the residents in Florida and lower the costs of providing health care benefits. Utilization management has become a great asset in diminish costs for the organization allowing for benefits to be distributed to more members who are in need of medical care.The consolidations of Managed Care Organizations (MCOs) into Health Maintenance Organizations (HMOs) or the Provider service of process Network (PSN) will allow the members to receive services from a bulky of in-network providers and achieve a higher quality of care. The transit will outset taking affect August of 2013 and will continue through 2014 until the transition is complete. The not knowing how the reform affects our jobs is what is most daunting.Getting the proper facts and also communicating with your employer to get a better understanding on their action plan for the provisions of the health car e reform are most encouraging. keen what is currently happening, what is going to happen, and where you will be situated at the end of the day is what matters the mostespecially in this economy. Conclusion The Patient Protection and Affordable Care Act will help the nation to provide health care access to all U. S. citizens.The provisions in health care reform act will allow all uninsured individuals to acquire at least some typeface of basic health care coverage through government programs or employeroffered health insurance plans starting as early as January 2014. Small and large business employers are able to register now to provide health insurance benefits to their employees at a tax credit or some type of incentive if they have not done so already. Preventing the costly hospital claims by offering preventative care to individuals will not wholly save lives, but will also lower the costs of hospital bills which, unfortunately, are later paid by taxpayers.