Cigna Case Study

1. Using the historical data as a guide (Exhibit 6.1), construct a pro forma (forecasted) profit and loss statement for the clinic's average month for all of 2010 assuming the status quo. With no change in volume (utilization), is the clinic projected to make a profit?

When senior executive at Best Employer Company (Heather) was vacationing in the USA, she expected to return injury free. As Human Resource Manager, it is my responsibility to familiarize myself with the company benefits and inform Heather of the details. I feel the information below is well researched and offer good support about why I selected each benefit.

CVS Health announced in 2014 that it wanted to stop selling all tobacco related products. This will affect every CVS location in the United States of America. The problem that arises in the U.S. is the usage of tobacco products. As a successful pharmacy chain and a lucrative company, CVS health wants to do its best to strengthen the health of American citizens. In order to solve the tobacco problem, the health professionals are taking it upon themselves to make a difference. If the distribution of tobacco products come to a halt at CVS pharmacies, consumers will either stop buying the products all together or looking for the products elsewhere.

As the industry continues to move away from some of the Medicare programs that were created during the Obama presidency,  the Centers for Medicare & Medicaid Services (CMS) is also pulling away from specific value-based initiatives, such as mandatory bundled payments. The CMS officially canceled two of the models that were included in the Bundled Payments for Care Improvement (BPCI) Initiative.

Anthem Blue Cross of California: Advantage HMO, Advantage PPO, Anthem Blue Cross, HMO, also sometimes known as California Care or Rural Cal Care (includes Cal PERS Traditional HMO), Anthem Blue Cross, HMO/POS (California Care Plus), Anthem Blue Cross, Individual HMO as known as California Care,Anthem Blue Cross Plus (POS), Anthem Blue Cross Small Group HMO as known as California Care (California Pacific Medical Center, 2015). More insurances are Behavioral Health Program, Blue Cross PPO, Prudent Buyer Plan, includes PERS Care and PERS Choice, Blue Cross Senior Advantage Care Plan, Blue Cross Senior Classic Plans; Classic A through L Blue Cross Senior Smart Choice, Preferred and Plus Plans, Blue Card Cal PERS EPO, Del Norte County, EPO Federal

CVS health hasn’t always been that name at one point they went by CVS Caremark and still some of the things they have out there are named CVS Caremark. The main corporation is based out of Woonsocket Rhode Island. There are roughly 8,500 CVS Health pharmacies and clinics around the world with more to be built eventually. CVS Health is ranked number ten on the fortune 500 and has went up in ranking yearly. CVS stands for convenience, value, service.

The metropolitan classification program is used to determine home mortgage loans, loyalty pay program and varying policies within the Medicare program. The geographic established boundaries of a metropolitan area are representative of that area’s marketplace. Property data collected from the area is reported to bank regulators who will use the data to evaluate lending performance. The data collected could potentially cause bank regulators to consider altering lending practices to suit the area.

Regence Blue Shield of Washington is a subsidiary of Cambia Health Solutions (formerly the Regence Group) a nonprofit health insurance company founded in 1917. Regence Blue Shield is one of the largest health insurance carriers in the Washington state. Regence offers Employer, Individual and Managed Medicare coverage. In the 2014 Regence Year in Review, they insure over 1 million consumers, have 1,800 employees, and contract with over 34,700 providers in 748 in network facilities. In 2014 Regence Blue Shield was the number 3 Accident and Health Line of Business of the Top 40 Authorized Companies in State of Washington according to the annual report.

Crystal is well informed of the changing DSDS policy and procedures, and implements them with no reminders. She is able to quickly identify participants who are eligible for HCB Medicaid and make the appropriate referrals. Crystal continues to show that she understands the importance of confidentiality and HIPAA. She is able to identify eligible adults for HCBS through using the InterRAI assessment tool. Crystal continues to consult with her supervisor on challenges that may come up on cases. She works with other agencies to ensure that participants unmet needs are

In a study using Medicare administrative data, the cost of services delivered by APRNs and physicians was analyzed and found the cost of delivered by APRNs was 11-29% lower than the same care performed by physicians. Even after adjusting for lower reimbursement rates for APRNs, the study found an 18% cost

It was in 1977 that the United Healthcare United Health group was founded by Richard Burke. The headquarters of the company are in Minnetonka, Minnesota. This organization works towards the betterment of people's health, it help them in living a healthy life by providing them with the kind of health care that would be best for them. The main focus of United Healthcare which is a major division of the United Health group is to provide the people with better health benefits and coverage.

I think you should review the patient account b/c on PM shows that the patient is active with BCBS effective 04/01/2016 .The receptionist should be see that and verify insurance coverage at the moment the patient was registered. If the insurance was inactive the receptionist should be expired the Insurance.

The Omega Ultrasound System would be the best choice to green light for the Healthymagination initiative. After assessing all the potential products, we determined that the lack of concrete metrics, difficulty or uncertainty in measuring outcomes, or clinical relevance to the Healthymagination goal rendered the TEEMax, UltraLipo, and HepEcho unfit for launch. We’ve outlined justification for this decision in (Figure 1.), but we believe the Omega system provides the greatest opportunity for meeting Healthymagination standards with the best chance of obtaining definitive evidence to support the certification.

Columbus Regional Health (n.d.) serves 10 counties in Southeast Indiana. The demographics include a predominantly Caucasian population of approximately 300,000 people (Economic Opportunities through Education by 2015, n.d.). In southeastern Indiana, about 140,000 individuals have employment, and 15% of them, who are over the age of 24, have a bachelor’s degree (Economic Opportunities through Education by 2015, n.d.). Approximately 30% of the high-school students drop out in this mainly rural area with a flat population growth (Economic Opportunities through Education by 2015, n.d.).

The Fortune 500 company I chose is CVS Health. I chose this for a few different reasons. First, I recently had to visit the Minute Clinic in the CVS store twice within the last month. Secondly, I chose CVS because it is part of the health care initiative and I work for a healthcare company.