Using the following information answer the following questions: Many consumer an
ID: 125697 • Letter: U
Question
Using the following information answer the following questions:
Many consumer and health care advocacy initiatives are converging toward a mandate to provide public access to many types of information about managed care organization (MCO) performance, costs, and quality. In fact, employers in the many parts of the country who are the major purchasers of health insurance are now requiring MCOs to make “health plan performance data” available to subscribers to facilitate their choice of plans.
1.) Discuss and provide the rationale for your opinion on providing data in areas such as patient outcomes, compliance with national standards for preventive and chronic care, and comparative costs to the public.
2.)What obligation, if any, does an employer, and/or MCO have to educate subscribers in how to interpret performance data? At whose expense should such education be provided?
3.)What are the possible benefits or disadvantages to making such performance data available to the public?
Explanation / Answer
Answer 1:MCOs provide various plans and purchasing a health care plan by normal peoples would always be the major decision and considered as an expensive one in terms of comparative cost of plan. Before selecting consumers must be informed in order to choose a proper and besthealth plan for themselves and their family members. However, research data suggest that choosing a health insurance plan, which offers the most comprehensive coverage, so that the consumer must be sure for any future existing personal health needs. From the selected article of Florida, data suggest that 254,321 Medicaid patients admitted to short-term in general hospital in Floridaand study includes possible factors that were associated with preventable hospitalizations. Overall, data suggest that these type of customer care has no clear/direct benefit in Medicaid managed care patients. The reason being the lower capitation rate that was found to be associated with a greater likelihood of preventable hospitalizations for MCOs care patients. In addition, the comparative care are very high due to high competitions among the policy makers, and chronic care treatment is very difficult to obtain (Laditka, Laditka, & Probst, 2009).
Answer 2: In order to interpret data, several obligation can be come in picture like payment, work pressure, Cost Containment, interface with other departments, rest hours, rate of pays, leave, taxes, etc. in general, all the employers are always responsible for ensuring their employees that they receive certain basic employment rights or other related information’s. However, most of the rights are generally governed by the employment legislation and must be provided. Further such education expenses must be beard by the employers to educate the subscribers. In general, if somebody is employ persons or going to setup a business that will employ people, so most of the responsibilities are from employees’ rights. Along with these obligations, emergency physicians could accept some specific ethical obligations, which might arise out of the special features in case of any emergency medical practice (Park, & Lee, 2014).
Answer 3: If the performance evaluations data are available to the public, as this is one of the important tools used by health care management to review and discuss the employees' performances. Many types of performance evaluations exist, which would be directly affected in case the data is available to the public. The benefits includes Resource management, Outcome improvement, Teamwork, Patient satisfaction, Staff morale, Reliable documentation, Cost minimization, Hospital image, Educational benefits, Processual improvement, and Attractiveness to public. Besides, some dangerous disadvantage could always occurred while displaying the data, these are Mission deviation, Resource diversion, Workload, Costly, Discouragement, Routinization and Bureaucratization, Program Incongruence, and Judgmental nature. These all things will deviate the main mission of organization of helping the patients. Overall, the managers and the decision-makers of the MCO would decide and take the decision associated with significant advantages or disadvantages of the program, in order to enhance the health care organization performance (Dianis & Cummings, 1998).
References:
1. Dianis, N. & Cummings, C. (1998). An Interdisciplinary Approach to Process Performance Improvement. Journal Of Nursing Care Quality, 12(4), 49-59.
2. Paul Duncan, R., Lemak, C., Bruce Vogel, W., Johnson, C., Hall, A., & Porter, C. (2008). Evaluating Florida's Medicaid Provider Services Network Demonstration. Health Services Research, 43(1p2), 384-400.
3. Laditka, J., Laditka, S., & Probst, J. (2009). Health care access in rural areas: Evidence that hospitalization for ambulatory care-sensitive conditions in the United States may increase with the level of rurality. Health & Place, 15(3), 761-770.
4. Park, J., & Lee, K.-H. (2014). The association between managed care enrollments and potentially preventable hospitalization among adult Medicaid recipients in Florida. BMC Health Services Research, 14, 247. http://doi.org/10.1186/1472-6963-14-247
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