Capitated Managed Care Case Summary

Even though within the Managed care trends there have been many rapid transformations throughout the years with the HIPAA laws enforcements throughout health care facilities within the United States and Obamacare. Currently, there are challenges ahead with the healthcare reform due to the new presidency stirring up changes with health insurance and getting rid of Obamacare. Throughout the managed care trends chronic condition management have affected two-thirds of the baby boomer’s generation causing them to have chronic health conditions that them to receive medical treatment constantly with elevated health care cost. Next, a trend of having the options available for mobile health has grown tremendously by allowing many a chance to gain access

1.) What is the marginal cost estimate of the Phase 4 hospital services, assuming that 60 percent of the designated costs are fixed and the remaining costs are variable?

Currently the clinic sees about 45 patients per day and they have capacity to handle 85. If they continue how they are operating the clinic is looking at a loss of $3,173. At this rate the clinic will not be able to make a profit in spite of inflation over the next couple years.

The second is to consider that costs in California heath care are rising and California hospital costs was based on price competition that was created by the process of selective contracting according to researchers which has also resulted in the threat to patients. Thus the factors that play a decisive role in the health care strategy are "expenses to patient volume, case-mix, hospital specialization, hospital size, ownership, location," (Zwanziger; Melnick; Bamezai, 1994) and such factors. The hospitals that are going to be compared are the Irvine Medical Center, Ronald Reagan UCLA Medical Center, and the Cedars-Sinai Medical Center.

Under the current indirect cost allocation scheme (Exhibit 1) the Dialysis Center’s Revenues and Direct Costs are as follows: total revenue is $2,700,000, direct expenses are $2,100,000, the contribution margin is $600,000, and their percent of revenues is 22.2%. Their indirect costs are as follows: facilities cost is $300,000, general overhead is $270,000, and total overhead is $570,000. This leaves the Dialysis Center with $30,000 in net profit and 1.1% in percent of revenues. Additionally, square footage is allocated at $15.00 per square foot on an aggregated basis. Lastly, their general overhead costs are set at 10% of their total revenues.

The Medicare and Medicaid programs were signed into law on July 30, 1965 by president, Lyndon Baines Johnson. The Centers for Medicare & Medicaid Services (CMS) is an agency within the US Department of Health & Human Services in charge of administration of several key federal health care programs. CMS is responsible for health care programs such as, the Health Insurance Portability and Accountability Act (HIPAA), the Clinical Laboratory Improvement Amendments (CLIA), and the Children’s Health Program (CHIP) amongst other services.

We've had some major news stories about MA Plans overcharging lately. What exactly are they about?

Model Description The model takes much of the busywork out of the case, enabling students to spend more time on interpretation and evaluation. Like most case models, the student and instructor versions differ only in regard to the input data. The instructor’s version contains the complete base case inputs, while these inputs are zeroed out in the student version of the model. The model for this case takes the input data (cost pool values and allocation rates) and allocates overhead costs from the three overhead departments to the three patient services departments using all four allocation methods. Additionally, the model calculates the profitability of each patient services department under each allocation method. The model’s (instructor’s version) Input Data and Key Output sections are as follows:

The U.S has many payer systems which many believe it to be its downfall among other countries. This may be because many view it more as an economic business and not an overall wellness plan. The United States’ main public program of funding is Medicare, which once followed a standard form of payment. It is now envisioned as a futuristic model that encompasses the payments of providers. Medicare is a national social insurance program that is run by the government since 1966. Also unlike Great Britain system, the program provides health care to Americans over 65 years of age for those who have paid their work dues in the system. Medicare has also extended its reach to those Americans who may be veterans or disabled. Another huge form of payment to providers is through Managed care which can be beneficial to physicians in the fee for service and capitation aspect. While this form of payment is similar to Great Britain’s programs, their execution of it remains vastly different. Managed Care is a type of healthcare system with health care plans that has restrictions on its selection of facilities and health care providers at a reduced cost for the patient. Rather than come to a conclusion about better ways to negotiate with payers, U.S providers continue to rage war against

Medicaid is a federal grant given to states, disbursed to counties to provider insurance coverage for select populations. These populations include low-income families with minor children, pregnant women, coverage for nursing homes and as a secondary coverage to Medicare. Santa Clara County has a very high population of patients who receive Medi-Cal, California’s version of Medicaid. Individuals would either go to the Santa Clara County Social Services Agency or to a Financial Counselor’s office at SCVHHS to apply for coverage, which requires producing the required documentation.

The Basic Health program could be structure in several ways. It could expand programs such as Medicaid and CHIP and contract with managed care plans on behalf of its Medicaid and CHIP beneficiaries outside the private insurance market. These changes would allow both programs to continue as a "separate program with a separate financing mechanism and risk pool from that of Medicaid and CHIP, but would leverage the state's existing infrastructure for information technology, contracting, rate setting, and other function" (Angeles, 2012). Alternatively, a state could expand the Medicaid managed care by increasing the number and types of service through different network of providers, other than those that serve Medicaid and CHIP beneficiaries (Angeles,

If Marlene Herbert were to discontinue place mats, he would miss $270,000 that will go toward Mendel paper company fixed cost. The company currently has a plant overhead that is estimated at $420,000 for the quarter. In addition to the fixed plant overhead, the plant incurs fixed selling and administrative expenses per quarter of $118,000. This draws the company to a total fixed cost of $538,000. If Marlene Herbert were to discontinue the second highest contributor to the fixed cost, he would need to increase the volume of computer paper and lower material cost to help pull the contribution margin of the lowest product up to help support the lost of a whole product line.

Kaiser Permanente Colorado is proud to offer a program that allows safety net primary care providers to electronically request advice from select Kaiser Permanente specialists. Currently eight speciality departments participate in this program that supports safety net primary care providers, the patients are uninsured and below the federal poverty level.

What would happen financially to a health services organization over time if its prices were set at:

Providing quality delivery care is the cornerstone of Kaiser operation and addressing language needs of the diverse communities it serves is receiving attention from the National Diversity and Inclusion Office. Kaiser’s National Diversity and Inclusion was established with the objective to promote, support, and assist the regions in implementing the Kaiser Permanente Board of Directors agenda in providing culturally competent medical care and culturally appropriate services to improve the health and satisfaction of its members.