Healthcare

Management
Managed Care
Organizations
Group 2
HSC100

History of Healthcare
Management
1929- Dr. Justin Ford Kimball at Baylor Hospital in Texas establishes The Baylor

Plan, a prepaid hospitalization plan that first uses the Blue Cross logo
1938- Henry J Kaiser recruits Dr. Garfield to establish prepaid clinic and hospital
care for his Grand Coulee Dam project in Washington
1939- Blue Shield program adopted for participating prepaid physician plans
1945 -Group Health Cooperative of Puget Sound established in Seattle, WA
Permanente Health Plans opens to the public in California, in addition to serving
Kaiser employees
1947- Health Insurance Plan (HIP) of Greater NY established to serve NY city
employees
1952- Permanente Health Plans changes name to Kaiser, while medical group
retains Permanente name. Kaiser membership at 250,000
1973- HMO Act of 1973 signed into law by President Nixon, using federal funds
and policy to promote HMOs
1982- California legislation enacted allowing selective contracting for Medicaid
and private insurance, paving the way for other states to enact similar laws
facilitating Preferred Provider Organizations (PPOs)
1990- National total HMO enrollment reaches 33.3 million
National PPO enrollment surpasses HMO enrollment with 38.1 million members
NCQA established
1996- Health Insurance Portability & Accountability Act of 1996 (HIPAA) includes
patient privacy compliance and health plan portability provisions

2000 - National total HMO enrollment is 80.9 million, declining for the first time from
the previous year's level (81.3 million in 1999)

2003- Medicare Modernization Act establishes Part D drug benefit, establishes HSAs,
renames Medicare+Choice program to Medicare Advantage and increases payment
rates to Medicare Advantage plans

2004- National total HMO enrollment is 68.8, and national PPO enrollment is 109
million

2006- National total HMO enrollment is 67.7, and national PPO enrollment is 108
million
Medicare Part D prescription benefit becomes effective
2010- Affordable Care Act (ACA) is approved by Congress and signed into law, including
provisions to allow increased access to healthcare for Americans, creates incentives
focused on quality, and changes certain payment systems to reward value
2011- Final rule for Accountable Care Organizations (ACOs) released by CMS to create
incentives for health care providers to better coordinate care
-CMS established the Shared Savings Program to reward ACOs who lower growth of
health care costs while meeting quality of care standards
-The first 32 organizations sign agreements with CMS to participate in the Pioneer
ACO Model initiative beginning 2012

2012- Affordable Care Act (ACA) upheld by Supreme Court

2013- There were an estimated 428 ACOs in 49 states

-Open enrollment in the Health Insurance Marketplace begins

2014- Coverage begins under plans purchased in the Health Insurance Marketplace.
-More than 8 million enrollees selected Marketplace plans during open enrollment.

History of within the School of

Allied Health
Dr. Lewis has been a faculty member in the Health Care Management Division for
fourteen years. During this time she has served as Interim Division Director on two
separate occasions, in 2001, and for the period 2006 2008.
The primary mission of the Division of Health Care Management at Florida A&M
University is to provide high quality education in the theoretical and technical
aspects of health services administration to aspiring and practicing health care
managers. The undergraduate curriculum is designed to develop the knowledge,
attitude, and skills required for entry-level managerial positions in various settings.
These settings include hospitals, ambulatory care facilities, wellness centers,
medical group practices, government agencies, insurance corporations, mental
health agencies, managed care organizations, hospice agencies and long-term care
facilities

Purpose of the Profession

What do professionals in the field actually do?
They are in charge of keeping medical practices running smoothly.
They do not work with the patients like other health specialists, but
instead focus on the business aspects of operating a medical office.
Responsibilities include: Hiring staff, ordering supplies, overseeing staff
members, insurance, and making sure there is a budget.

How do they practice the profession?

They obtain a job either in a hospital, physician office, or nursing homes and fulfill the duties
listed above.

Educational Requirements and

Programs
A 2.0 GPA or higher is required for the BSHC (FAMU)
An associates degree in a field relevant to health care
management is sometimes accepted.
A bachelors degree is often recommended rather than an
associates degree.
Some employers today may even require a masters degree.
There are 64 universities in the US that offer a health care
management degree.

Activities of the Professional

Association
The professional association is involved in
Computer programing
Financial systems
Clinical activities
Clinical research

Work Settings

Hospitals and Medical Centers

Nursing Homes
Ambulatory Care Centers
Outpatient health facilities
Medical Supply Companies
Health Insurance Companies
Managed Care Organizations
Community-based Rehabilitation
Centers

Home Health Agencies

Health Care Professional Associations

Adult Day Care Centers

Medical Group Practices

Mental Health Centers

Community Health Centers

Drug Treatment Facilities

Health Care Consulting Firms

Government Health Agencies

How do patients/clients might benefit from the

services provided by the profession?
Patients benefit by Health Care Management Services
because they maintain & assemble networks of providers
to deliver services
Market those services primarily to employers
Financial services Processing claims

Number of Practitioners
According to the Bureau of Labor Statistics, in 2012 there
were 315,500 Healthcare Management jobs in the United
States.

Types of activities that professionals within this

professional association engage in?

Managed care organization participate in programs such

as ones that expand manage care to traditionally exempt
populations, and a boarder set of services like long-term
care and behavioral health.
They contract with risk-based managed care orgs and or
reporting a primary care case management program.

Types of activities that students affiliated with this

professional association engage in

Shadowing professionals and or interning in local

hospitals or clinics
There students will demonstrate appropriate behavior in
areas of health care ethics, work ethics, maturity, and
business etiquette.

Current issues within the field

Enhancing patient experience through personalization of
health services
Triage in times of drug shortage
Racial and health disparities
Gender disparities

Major Contributions of the Field

Health care management allows opportunities to make contributions in

health care settings.

One idea in health care management can be used in a hospital, nursing
home, doctors office, or clinic.
The idea of using a checklist or now electronic records was an idea that
affected all aspects of the health care management settings.
With health care reform in place, the skills and knowledge of health care
management is needed to ensure that patients needs are met in every way.
Most of the decisions made by government entities, such as CMS (centers
for Medicare and Medicaid services), are health care management based.

Description of an activity of this professional group

with a particular client/patient population?
In managed care organizations, health care managers are
the ones who partake in activities such as ordering
supplies needed for the center, budgeting funds on the
organization, and hiring staff members
They are in charge of dealing with insurance in managed
care organizations which can include either HMOs and
PPOs.