PROVIDE A RESPONSE OR STATEMENT TO THIS STUDENTS DISCUSSION: My family has been
ID: 123705 • Letter: P
Question
PROVIDE A RESPONSE OR STATEMENT TO THIS STUDENTS DISCUSSION:
My family has been fortunate in that we had Tri-care for insurance, which is one of the best plans that you can have. It is just recently that we have had to select a managed care organization (MCO) plan due to my husband’s retirement from the military. With this decision, I research the pros and cons of HMOs versus PPOs and liked the ability to choose what provider I wanted instead of being required to have primary care provider (PCP). In addition, not being mandated to have prior authorizations and referrals before seeing specialist is also an added benefit. The ability to receive out of network is also a plus. Although these are benefits of a PPO plan, the con is that the out of pocket percentage is 40% instead 20% if an in network provider is chosen. However, the alternate to paying 100 % of HMOs and EPOs out of network care is a substantial savings (California Public Employees Retirement System, 2018).
I totally disagree that there is a consistent, direct correlation between the cost of care and its quality in a managed care program. For example, take participates in Medicaid plans. For example if a patient has a tooth that has an endodontic abscess, instead of getting a root canal to save the tooth, this particular plan and requires the patient to get the tooth extracted instead of the alternative. This is because only certain places accept this plan and the plan will pay in full to have the tooth extracted rather than pay for the root canal to save the tooth. I know this because I am a dental professional.
The Accountable Care Organizations (ACO) is the new model of MCOs. Care providers that are a part of a ACO are held accountable not only for providing quality care for their patients but also for keeping the cost associated with care low (Innovation Exchange Team, 2013). Choice for autonomy to access to healthcare will be taken seriously with ACOs in comparison to traditional managed care organizations.
Keeping patients well, will be the incentive physicians strive for in order in to receive financial rewards for managing cost; in order to ensure this, ACOs require participates to meet certain goals for specific patients. Another incentive is the physicians and groups who participate will be allocated a certain sum of money for each patient and must use the money wisely. If the dollars that are spent goes beyond the allocated amount, the care provider or group will be responsible for the difference placing them at a financial risk (Innovation Exchange Team, 2013
Explanation / Answer
Here having a tri caring system better to go for accountable care organisation because you will get. Better treatment and secure for health
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