PROVIDE A RESPONSE OR STATEMENT TO THIS STUDENTS DISCUSSION: Q1. Please share yo
ID: 123774 • Letter: P
Question
PROVIDE A RESPONSE OR STATEMENT TO THIS STUDENTS DISCUSSION:
Q1. Please share your experience on selecting a managed care plan. Please discuss the advantages and disadvantages of your MCO plan.
A1. I’ve not experienced selecting a healthcare plan. Early in my adult life I enlisted in the military at the age of 18 and was provided healthcare through a Military Treatment Facility or referral in the local community through TRICARE (a type of HMO plan). I am assigned a provider and that provider manages my care; my choices are limited. Referrals must be coordinated and approved by my provider in advance. Additionally, I do not typically choice the specialty referral facility/provider; it is selected based on in-network providers through TRICARE. I’ve not had any issues with this type of managed care and have a positive view of my healthcare needs being met.
Q2. 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?
A2. I often think about this, specifically in regard to capitation. For instance, my insurance coverage agrees to pay $30 for an office visit while the totality of the bill is much more at $130 per visit. In the back of my mind I am thinking about the quality of care versus quantity as this model seems to thrive from. I have no personal examples where the cost of care had a direct effect on the quality of care I received. I believe there is goal to improve quality of care. One such initiative is the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey sent to patients for their perspective on measuring the quality of care they received (BCBS, 2014). The survey help consumers make an informed decision. Similar to the popular app Yelp.
Q3. Do you think patient’s choice of provider and access to care will be limited under ACOs?
A3. I do not think that choice is limited under an ACO. In fact, over 23 million Americans are on a type of ACO (Gold, 2015). An ACO brings together a network of providers (specialty and otherwise) to provide service to a patient.
Q4. In what ways can an ACO succeed in both delivering high-quality care and spending health care dollars more wisely? A traditional fee-for-service drives up costs by billing per visit/procedure/exam. An ACO provides participating organizations a bonus to keep costs lower and mitigate unnecessary visits/procerfures/exams.
Explanation / Answer
This conversation is regarding the advantages & disadvantages of some health insurance models in US.
Points of this conversation:
Q1: Advantages & disadvantages of Managed care:
Advantages:
Disadvantages:
Q2: Many people's having an doubt regarding the correlation between quality of care & cost of care. Many health care organizations& insurance companies doing some shows about the quality of care in our organisations. One such initiative is the Hospital Consumer Assessment of Health care Providers Systems (HCAHPS).
They are sending an survey regarding the quality of care they received. Similarly an application called "Yelp" is using.
Q3: ACO (Accountable Care Organizations) are groups of doctors, hospitals, and other health care Providers, who came voluntarily to give coordinated high quality care to their medicare patients.
In ACO, Medicare patients who see Providers that are participating in Medicare ACO. Rights to choose any doctors and Providers that accept Medicare.
Q4: In ACO, using primary tools for reshaping both the delivery system & payment system, moving us away from fee for service medicine that pays every provider for every service they do, to a system that consistently rewards hospitals, doctors, and others for providing high quality care.
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