Hcs 235 Week Health Care Utilization Paper

health C be drill Paper HCS/235 Health C be saving in the U. S. Health Care Reform The Patient Protection and low-priced Care correspond of 2010 (PPACA) was designed to mitigate health mission follow and require health kick entrance to all U. S. citizens. The morsel has the strength for reducing the appeal of health care in the United States however, with numerous risks which could possibly strain the health care system, increase debt, and decrease the timbre of care many are concerned. Access to Care The PPACA was en proceeded in 2010 however, the Act was non completely implemented right away.The health care reclaim has been dispersing provisions as the years progressed. Provisions such as plainly investing in new resources to fight against fraud, waste, and abuse in government sponsored programs such as Medicare and Medicaid bequeath strengthen the quality of the programs and also treasure imposepayers m adepty. Under the Affordable Care Actyoung adults are get outed to continue in their parents health insurance plans until they reach twenty hexad years of time, unless the young adult has health care insurance below their own employer.In the past, medical exam exam health insurance companies have denied payments for patients who got sick. Incidents where breast genus Cancer patients were found to have lost medical coverage from their insurance companies aft(prenominal) diagnosed with the major disease. The Act makes this pretendion illegal for insurance companies to rescind medical benefits. The purpose of the PPACA is to bid health care services to all Americans, whether through with(predicate) government programs or employeroffered health insurance plans. The Act provides small businesses and near large businesses with tax credits for providing health care benefits to their employees.Huge investments are located into prevention. Preventing diseases and illnesses with free load care to individuals depart imp make a mot ion the monetary values of parking brake room claims from individuals who wait until their diseases or sickness is unbearable. Emergency room claims are far more expensive than preventative care. Keeping previously uninsurable individuals sinewy before they join Medicare reduces the cost burdens of taxpayer dollars for uninsured patients receiving care at hospitals which go un stipendiary and drive the cost of health care. UtilizationUtilization management has interpreted a key role in the health revitalize act because it evaluates the need, appropriateness, and the efficiency of the health care services which will be employ by the covered individual. Health insurance plans are pressured to find slipway to reduce plan costs and improve the quality of care provided to their members. Utilization management efforts have reduced inappropriate services and high medical costs just by taking some time to fall over 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. Use 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 goal of providing health care benefits for all U. S. citizens is a goal that is not new in our health care system and still lingers to be resolved by government officials.The health reform acts provisions are stated to achieve these goals. The Medicaid expansion could possibly insure 21. 3 billion 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 turn nineteen years of age and classified as adults, and low-income adults with disabilities who do not qualify for Social hostage 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 effective 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. ain 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 e xpansion in the state of Florida will allow more residents to acquire health care benefits which eventually will improve the overall health of the residents in Florida and cast down the costs of providing health care benefits. Utilization management has become a great asset in decreasing 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 Network (PSN) will allow the members to receive services from a vast of in-network providers and achieve a higher(prenominal) quality of care. The transition will start taking affect noble-minded 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 weaken understanding on their action plan for t he provisions of the health care reform are most encouraging. Knowing 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 most in particular 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 to the lowest degree some type of basic health care coverage through government programs or employeroffered health insurance plans starting as first as January 2014. Small and large business employers are able to render 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 only save lives, but will also lower the costs of hospital bills which, unfortunately, are later paid by taxpayers.