PROVIDE A RESPONSE OR STATEMENT TO THIS STUDENTS DISCUSSION: Please share your e
ID: 123592 • Letter: P
Question
PROVIDE A RESPONSE OR STATEMENT TO THIS STUDENTS DISCUSSION:
Please share your experience on selecting a managed care plan. Please discuss the advantages and disadvantages of your MCO plan.
Many argue that there is no consistent, direct correlation between the cost of care and its quality in a managed care program. Do you agree or disagree?
Do you think patient’s choice of provider and access to care will be limited under ACOs?
In what ways can an ACO succeed in both delivering high-quality care and spending health care dollars more wisely?
1. My employer offers two health care plans, one is a PPO and the other is a HMO. The PPO offers in-network and out-of-network benefits. The HMO has a large provider network within my state and will provide coverage for seeing any provider if I am sick or injured when out of my state. My regular doctor and specialists were in the HMO network already. The HMO co-payments are pretty much equivalent to the in-network co-pays of the PPO. Additionally, the HMO had a zero deductible, as opposed to the $250 per person deductible of the PPO. Last, the PPO premium for family coverage is a few hundred more dollars per month. For those reasons, I chose the HMO, have been very satisfied with the coverage, and can’t identify any disadvantages of my plan.
2. I agree to an extent that there is no consistent correlation between the cost of care and its quality in a managed care program. I believe that providers have the basic knowledge and skills to treat many common diseases and that all doctor’s offices and facilities have the knowledge and equipment necessary to treat them successfully. A country doctor without the newest technology or a bright shiny new building, may even do a better job because he has more time to interact with each patient if he is not struggling to crank out as many patients as possible per day to pay a high overhead for his office.
3. I do think that patient’s choice of providers will be limited under ACOs, but not access to care. I think the ACO will make sure it has a sufficient number of providers to serve the population it manages. The ACO has a contractual duty to provide the services needed for their Medicare recipients (Lupinacci, 2016).
4. An ACO can succeed in delivering high-quality care and spending health care dollars more wisely by developing relationships with patients that earns their trust, not ordering unnecessary tests, staying current and utilizing evidenced-based practice, and by having affiliates that connect patients to community resources to help manage chronic diseases.
Explanation / Answer
Please share your experience on selecting a managed care plan. Please discuss the advantages and disadvantages of your MCO plan
Answer:-
I would go for HMO plan.
Pros:-
The benefits of a Health Maintenance Organization can diverge depending on the company and group plan. Your HMO may cover health screenings, cancer screening, preventive care, immunizations, pathological test, prescribed medications, surgical treatments and many other. The HMOs generally cover prenatal care and baby care. Make sure you understand the specific benefits offered by your HMO policy and ask questions if you are confused or unsure about the HMO's benefits. The HMO policy that outlines the different benefits provided.
Cons: -
The premium that is paid is just adequate to cover the costs of doctors in the network. The insurer are stuck to a primary care physician and if managed care plans change, then the insurer may not be able to continue with the same PCP.
Direct correlation between the cost of care and its quality in a managed care program. Do you agree or disagree?
Answer:-
I am completely agreed that there is direct link in cost and quality of managed care program
Doctors has mostly negative opinions of the impression of managed care tools:
Gate-keeping, managed care networks, second opinion requirement, Pay for performance, Pay by salary, selective contracting, and pre-approval of expensive treatment. Estimated impacts on cost control is positive or neutral for most tools, the impacts on professional autonomy is predominantly negative. Primary care doctors held more positive opinions than doctors in other specialties, and psychiatrists are in general the most critical. Older doctors have more negative opinions, as well as those in private practice now a days.
Conclusions of the managed care is: -
Doctors perceived most managed care tools to have a positive impact on the control of health care costs but a negative impact on medical practice. Tools that are controlled by the profession were better accepted than those that are imposed by payers.
PART 2
Do you think patient’s choice of provider and access to care will be limited under ACOs?
Ans:- I don’t think so, nurturing accountability in the ACO programs may be challenging because outdated Medicare beneficiaries have unrestricted choice of health care providers, are attributed to ACOs based on utilization, and often receive fragmented care.
Regards
Have a happy reading..!
Related Questions
Navigate
Integrity-first tutoring: explanations and feedback only — we do not complete graded work. Learn more.