Health maintenance organizations (HMO) are organizations that provide or organize health insurance, self-funded health care benefits plans, individuals, and other entities for the United States as a liaison with health providers or hospitals on a prepaid basis. In this simulation a virtual organization Castor Collins Health Plans presented three HMO options to two organizations. I will review one of the company’s demographics, discuss the HMO choices, explain the differences in the choices presented, and why I chose the plan I chose. Company: Constructit Constructit consist of a 1000 employees (550 men and 450 women) ranging from ages 26 through 42 and 60 percent of them are married. Constructit has to consider in the number of employees that would covers their spouses or children for insurance coverage. Thirty-two of the workers are physical active and 25 percent are moderately physically active. There are 170 men and 210 women approximately 38 percent with no health issues. Ten percent of men and 8 percent of the women are heavy smokers. Obesity rate is also a problem with 39 percent being obese causing a heavy absenteeism for reason of high blood pressure, diabetes, heart issues, and hyperlipidemia. Knowing the demographics of Constructit, Castor is now charged with coming up with a plan that is profitable for Castor, but meets Constructit needs. There were two plans that were offered Castor Enhanced and Castor Standard. Insurance plan detailed Castor Standard and Enhanced are individual health plans. Castor standard does not cover preexisting medical conditions while the enhanced plan does. Castor Collins estimates the expected utilizations per year of various services. They compare average utilization of the services in th... ... middle of paper ... ... of an HMO costs less than comparable traditional health insurance, with a trade-off of limitations on the range of treatments that are available. As in the case of Constructit, appears to be a company that until now did offer insurance or at least an HMO plan. HMO is able to offer cheaper healthcare in one of two ways. Therefore, if you eliminate insurance coverage for treatments that the HMO views as unnecessary and focusing on preventative healthcare with an eye toward the long-term health of its members, the HMO is able to reduce its own costs. Castors standard plan did just that. The premium was low to meet Constrict needs, but the benefits standard offer was gear more toward the preventive, thus if those benefits are utilize more in the long run this will give Castor a even greater revenue as its member will be healthier and less pay out on high dollar claims.
Balance sheet lists assets, liabilities and owner’s equity. The assets listed on the balance sheet are acquired either by debt (liabilities) or equity. “Companies that use more debt than equity to finance assets have a high leverage ratio and an aggressive capital structure. A company that pays for assets with more equity than debt has a low leverage ratio and a conservative capital structure. That said, a high leverage ratio and/or an aggressive capital structure can also lead
To guarantee that its members receive appropriate, high level quality care in a cost-effective manner, each managed care organization (MCO) tailors its networks according to the characteristics of the providers, consumers, and competitors in a specific market. Other considerations for creating the network are the managed care organization's own goals for quality, accessibility, cost savings, and member satisfaction. Strategic planning for networks is a continuing process. In addition to an initial evaluation of its markets and goals, the managed care organization must periodically reevaluate its target markets and objectives. After reviewing the markets, then the organization must modify its network strategies accordingly to remain competitive in the rapidly changing healthcare industry. Coventry Health Care, Inc and its affiliated companies recognize the importance of developing and managing an adequate network of qualified providers to serve the need of customers and enrolled members (Coventry Health Care Intranet, Creasy and Spath, http://cvtynet/ ). "A central goal of managed care is containing the costs of delivering care, but the wide variety of organizations typically lumped together under the umbrella of managed care pursue this goal using combination of numerous strategies that vary from market to market and from organization to organization" (Baker , 2000, p.2).
It is enthralling to note that in spite of the advances in healthcare systems, such as our hospital’s ability to provide patients with lower cost, managed One being the Health Maintenance Organizations (HMO), which was first proposed in the 1960s by Dr. Paul Elwood in the "Health Maintenance Strategy”. The HMO concept was created to decrease increasing health care costs and was set in law as the Health Maintenance Organization Act of 1973, after promotion from the Nixon Administration. HMO would, in exchange for a fee, allow members access to employed physicians and facilities. In return, the HMO received market access and could earn federal development funds.
...ter for obese individuals than for average weight individuals. The healthier workers are, the fewer medical services they use. The five leading causes of death in the U.S., heart disease, cancer, stroke, chronic obstructive pulmonary disease and diabetes — are directly linked to unhealthy lifestyles. Clearly, encouraging healthful habits presents an opportunity to improve workers’ well being, reduce the need for medical services and help control costs.
When one examines managed health care and the hospitals that provide the care, a degree of variation is found in the treatment and care of their patients. This variation can be between hospitals or even between physicians within a health care network. For managed care companies the variation may be beneficial. This may provide them with opportunities to save money when it comes to paying for their policy holder’s care, however this large variation may also be detrimental to the insurance company. This would fall into the category of management of utilization, if hospitals and managed care organizations can control treatment utilization, they can control premium costs for both themselves and their customers (Rodwin 1996). If health care organizations can implement prevention as a way to warrant good health with their consumers, insurance companies can also illuminate unnecessary health care. These are just a few examples of how the health care industry can help benefit their patients, but that does not mean every issue involving physician over utilization or quality of care is erased because there is a management mechanism set in place.
Health Maintenance Organizations, or HMO’s, are a very important part of the American health care system. Also referred to as managed care programs, HMO's are combinations of doctors and insurance companies that are formed into one organization. This organization provides treatment to its members at fixed costs and decides on what treatment, if any, will be given based on the patient's or doctor's current health plan. Sometimes, no treatment is given at all. HMO's main concerns are to control costs and supposedly provide the best possible treatment to their patients. But it seems to the naked eye that instead their main goal is to get more people enrolled so that they can maintain or raise current premiums paid by consumers using their service. For HMO's, profit comes first- not patients' lives.
Hospital Corporation of America (HCA). Staff Analysis Statement of Problem HCA, after following a conservative financial policy since its establishment, has entered the new decade preparing to make some changes in order to realign their financial strategy and capital structure. Since its establishment, HCA has often been used as a measure for the entire proprietary hospital industry. Is it now time for the market to realign their expectations for the industry as a whole? HCA has target goals that need to be met in order to accomplish milestones in the future.
A managed care organization is a collection of clinics, doctors, hospitals, pharmacies and other healthcare providers who come together to offer health care to persons who are sign up for the services. In many cases, managed care organizations operate and are referred to as networks of health care providers. Managed care organizations are comprised of health care experts from different fields who come under an agreement to offer health care services to members. Once a member signs up, all their heath care needs are covered by the managed care organizations. Access to care outside the organization is restricted. Members under managed care organizations are usually assigned a primary care physician (PCP) who is the primary care giver for the member. The PCP is tasked with analyzing a member’s health problem before referring them to other sections of the managed care organization. Managed Care Organizations are usually well coordinated to meet the needs of members who have registered under their banner.
Managed care dominates health care in the United States. It is any health care delivery system that combines the functions of health insurance and the actual delivery of care, where costs and utilization of services are controlled by methods such as gatekeeping, case management, and utilization review. Different types of managed care plans came into development by three major factors. These factors include choice of providers, different ways of arranging the delivery of services, and payment and risk sharing. Types of managed care organizations include Health Maintenance Organizations (HMOs) which consist of five common models that differ according to how the HMO is related to the participating physicians, Preferred Provider Organizations (PPOs), Exclusive Provider Organizations (EPO), and Point of Service Plans (POS). `The information management system in a managed care organization is determined by the structure of the organization' (Peden,1998, p.90). The goal of a managed care system is to provide subscribers and dependants with needed health care services at the lowest possible cost. Certain managed care plans also focus on prevention by trying to keep members healthy.
Learning Experience Journal Entry – Director of Health Information Management and the Supervisor of Medical Records Coder
From the hospital perspective mandating the health insurance will reduce the problem of Free riders into the Hospital and if a person who is insured visits the hospital for the treatment the cost of his medical treatment will not be totally absorbed by the hospital if the person is unable to pay for the treatment and the amount will be shared between the hospital and the insurance company.
In order to keep health care cost down doctors, hospitals and insurance companies are encouraging patients to get exercise, watch their diets, keep active and have wellness and preventive medicine checks every six months or what your doctor suggest. For HMO plans you can only go to doctors, health care providers or hospitals that would carry this plan. So if you are thinking about doing the HMO plan, I would do some research on doctors to see what the doctor will take care of HMO and also check on their ratings to before you decided to go see that doctor(Health Maintenance Organization (HMO) Plan).
Health information management involves the practice of maintaining and taking care of health records in hospitals, health insurance companies and other health institutions, by the use of electronic means (McWay 176). Storage of medical information is carried out by health information management and HIT professionals using information systems that suit the needs of these institutions. This paper answers four major questions concerning health information systems.
This public health issue does not only effect individuals but the national as a whole in regards to the health care system costs. Obesity in children "costs the health care system $14 billion per year, much which comes from public funds" (Glanz, 2008). Also, obesity is expected to cause 112,000 deaths per year in the United States(Gollust, 2014). In addition, many changes seen in the health care sy...
An employee may find that their healthcare plan is provided by their employer and as such may find that even though their payment sums may be hefty, their employer may be paying even more. In a recent survey conducted by the Kaiser Family Foundation, only 30% of the cost for a doctor’s visit or family plan will be covered by the worker; therefore, the other 70% is then covered by the employer’s finances. With the average family health plan cost on the rise at $18,142, it may be a bit clearer as to why companies are searching for any means to lower this expense (Kaiser 2016). A corporate wellness program pitch loaded with quality statistics on the importance of preventative measures to effectively dodge physician bills then commodifies wellness as the straightforward answer to the issue of hefty expenditures. However, a substantial payment is not the only deterrent from seeking standardized