Aetna Insurance Research Paper

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

1. Kaiser Permanente starting in 1945 when Sydney Garfield and Henry Kaiser came together to form the healthcare system still used today. During the Industrial Revolution, many workers were found to have healthcare needs and not all were insured. In collaboration to help these members, Kaiser and Garfield created a system in which employers paid a set monthly premium and physicians joined a prepaid group practice in efforts to ensure care for all employees. This evolved Kaiser Permanente into the healthcare giant it is now.

Expansion of the MCO model occurred with the enactment of the Health Maintenance Organization Act of 1973. This Act provided the foundation for managed health care and required employers with greater than 25 employees to provide and HMO offering. The Act served to counter Democratic efforts to nationalize U.S. health care and to stimulate competition within the health care market. HMO’s also began the concept of for profit health care operations. While most health care providers are not for profit (Phelps, 2011) and number operate under a for profit model. Non-profit dominates the healthcare sector based on their tax exempt status.

However, when Private insurance companies soon joined the fray thereby creating stiff competition, costs were determined by a number of factors among them was the exclusion of the sick and the selective process of insuring only the healthy which meant more profit for the company because Blue Cross only provided coverage for hospital services. The Blue Shield plans were created in 1939 by employers in lumber and mining. This was done to ease the healthcare burden and bring satisfaction to both the physician and the patient. In 1982, The Blue Shield plan merged with The Blue Cross to form The Blue Cross and Blue Shield Association(4).

On March 23, 2010, President Barak Obama signed the Affordable Care Act (ACA) into affect in order to provide affordable, quality health care for all American citizens. The purpose of the ACA was to expand public and private insurance coverage opportunities, increase protections of the insured so they qualify for coverage, promote the overall wellness of the public and improve education on prevention, to improve the healthcare systems and the quality of healthcare professionals, to increase the amount of available healthcare workers, and to eradicate the rapidly increasing cost of receiving medical care (King, 2011). The ACA, also known as Obamacare, was created to reform the health insurance situation starting in 2010 and continuing through 2014. Some

The effect of the Affordable Care Act has created a positive influx on the major insurance carriers. According to the New York Times it has made insurers the “most direct beneficiaries of the law.” (investor pedia) Since 2013 these insurance companies have been some of the more profitable stars of Wall Street (Forbes.com). Aetna Inc., Anthem INC., Cigna, Humana Inc., and United Health Inc., the five biggest health insurers in America, have outperformed the S&P 500 Index over the last five years (invesotrpedia). One of the major reasons this is proved to be true is exchange premiums for the young and the healthy are much higher with Obamacare than ever before. As stated above The Affordable Care Act mandates that each individual must be insured

Nearly 30 years after the HMO Act was signed into law, HMO outnumbered private health care insurance plans and enrolled more than 80 million members.

4. one of the significant changes in the management of managed care organizations (MCOs) that occurred in the 1990s was:

The Affordable Care Act (ACA) was established by President Barrack Obama in March of 2010. Many believes this will be a healthcare insurance that people can

With Aetna HMO, a Primary Care Physician (PCP) gives fundamental social insurance benefits and organizes particular administrations when required. You can pick any PCP from the Aetna network. You will feel great realizing that anybody you pick meets our theirs standards. Picking a doctor is an individual choice, that is the reason every individual from your family can have his or her own particular PCP. You can change your PCP whenever need be. You should pick a PCP and see providers in the network to receive benefits from this plan. When you visit your PCP or a specialist, you will have to pay a copay fee.

COBRA medicinal insurance, short for the Consolidated Omnibus Budget Reconciliation Act was passed by Congress in 1986, to verify that individuals would not abruptly lose insurance on the off chance that they were terminated from, lost, resigned, quit, or were generally give up from their occupations. It was the first enactment of its kind to shield employees and their families from all of a sudden being without medical insurance and in charge of costly doctor's visit expenses, or more awful needing to go without health care by any means. It is likewise to a great degree imperative to individuals with previous health conditions on the grounds that it offers them constant coverage so they can't be denied later on from another health insurance plan. COBRA medicinal insurance is a program that permits an employer to decide to keep their group health insurance (from their former employer) for up to year and a half. Well known to opposite conviction, it is not an insurance plan on its on, but rather an approach to proceed with the insurance advantages you as of now had. Under the COBRA insurance law people who worked at companies with more than 20 representatives will qualify to choose COBRA medical insurance

Humana, Inc. is a health insurance company from Louisville, Kentucky that started in 1961 by Lawyers Wendell Cherry and David A. Jones, Sr. Humana started as a nursing home where it later become the largest nursing home company in the nation. After the nursing homes they soon began to purchase hospitals entirely for expansion. The name of the company changed to Humana, Inc. two years later. Cherry and Jones continued to expand by purchasing other companies. In 1984, the company began focusing on Health Insurance where it remains to focus on even today. Since 2014, Humana has had over 13 million customers and over 52,000, and a revenue of $41.3 billion that was reported in 2013.

With an evolving market in the various fields marketing, companies needed to readjust their and update their marketing strategies. Centuries ago, a company that needed to market for its products would just post a paper note at the main town street and if people liked the product it would be sold. In the 21st century, marketing became an essential field and necessary branch in any company that plans to succeed. Aetna recognized this necessity and while analyzing the company’s strategies and structure, one can recognize the un-doubtful organization in identifying their target market. Through the creation of different subsidiaries, Aetna, Inc. is able to organize its target market and classify their various services based on

The hospital industry has seen a dramatic change since the 1960s. Millions of dollars were poured into the industry causing a huge boom in independent hospitals and respectively a large boom in insurance coverage. Eventually the government had to step back in and reassess their role in health care. Here is what you need to know about the industry. Types of Health Care Programs: - HMOs are Health Maintenance Organizations that provide health care for a fixed monthly fee. - PPOs are Preferred Provider Organizations are usually offered through large employers where patients can more options and not be as restricted as an HMO. Ambulatory health care services are those that are used on an

Acuity insurance is a great place to work at because of their benefits and the environment of the company. Acuity offers perks and programs such as Magic Happens Gossip Line, Lunch with an officer, Wellness programs, 5 year club, etc. The company also provides compensation programs such as 10% of your 401 k. Acuity insurance mostly offers full time jobs (99% of their workforce.) The company understands how stressful work may be sometimes. The perks the company offers include; free snacks, free beverages, mailing services, banking services, dry cleaning, fitness classes, messages, discounted tickets, and most importantly is college tuition reimbursement. If you are the type of person who doesn't like to work too much at the office Acuity insurance