Preferred Provider Organization

As far as insurance plans go, generally there are three plans a patient will have, they are Health Maintenance Organization (HM0), Preferred Provider Organization (PPO) and Point-of-Service (POS).

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

Obamacare or the Affordable Care Act, implemented by President Barack Obama is the one of the major healthcare reform in America after Medicare’s implementation. Also it is one of the most debatable issues in the present times. Many are doubtful about its long term effects while many more are happy that they would finally be insured. It is of no doubt that the Obama Administration has brought in ACA with a very noble and optimistic intention of providing insurance and healthcare coverage to each and every citizen of America. However from a public administrative point of view it is essential to think about both the potential benefits and harms of this act on the healthcare economy. The reviewed articles discuss about why and how the ACA was implemented, how the architects are ACA are expecting it to benefit the society and what would be the effects of its implementation. The articles from healthcare journals discuss about the effects of ACA on the quality of healthcare.

The Affordable Care Act (ACA) has been a topic of dispute since its introduction and continues to be discussed by politicians in the U.S. and throughout the world even after its passage. The Act has many opponents and is the cause of much controversy nationwide, primarily because it introduces higher healthcare costs for the richest citizens. Nevertheless, the ACA is an important stage in the American healthcare development process as it not only allows more people to receive healthcare services, but will also reduce the deficit. However, not everyone agrees. The policy is controversial in terms of cost vs. benefits, but the benefits ultimately outweigh the costs.

There are several types of private payer plans including preferred provider organizations (PPO’s), health maintenance organizations (HMO’s), and point of service (POS). Indemnity plans would cost the most for employees and they usually choose a PPO plan. A trend that is gaining popularity with employees and employers is the consumer driven health plan (CDHP) that has a high deductable combined with a funding option of some type. All of the plans have unique features for coverage of services and financial responsibility.

Another type of managed care program that was introduced is the Preferred Provider Organization (PPO). A PPO is comprised of a group of physicians, hospitals and other medical service providers who contract with employers, insurance companies or other plan sponsors. The PPO offers discounted pricing to these contracted organizations due to the high volume of business received. PPO’s typically have up-front cost sharing in the form of deductibles and/or co-insurance, which vary depending upon the actual plan chosen.

EPO vs HMO-- EPO contracts solely with specific specialists, clinics, hospitals and other health care providers to form a network. EPO clients know they don't have many options when it comes to providers, but they do have the comfort of knowing they'll always be reimbursed for any in-network expenses. HMO’s requires a co-payment on each visit while EPO’s have no co-pays. Both EPO’s and HMO’s keep costs low. EPO’s do not require a referral while HMO’s must confirm that specialized care is required before they will issue a referral

After the inception of ACA that is Affordable Care Act on March 23, 2010 various policies and regulations has been proposed which has more controversy (www.healthcapital.com, 2013). Affordable health act has impact on the stakeholders in different manner. The main concern in the medical field is the input cost which is increasing continuously. This is the biggest challenge for the US government as the increasing cost makes it impossible for the government to allocate appropriate resources in managing the requirements of the ACA public policy. There are more initiatives taken by the US government in implementing the ACA in an appropriate manner by continuously improving the quality of health care at affordable lower costs

President Barack Obama signed the Affordable Care Act, into law on March 23rd 2010. Congress had tried for decades to pass health care reform, beginning with President Franklin Roosevelt. “Following President Obama’s inauguration, he used Democrat control of both the House of Representatives and the Senate to enact health care reform legislation, and granted the federal government control of over 16% of our nations economy” (Taylor 3). The law states that every American citizen is mandated to purchase health insurance. “If you choose not to obtain Health Insurance by January 2014, you will be penalized $95, or 1% of your income-whichever is greater” (Taylor 5). “The penalty rate for non-compliance will

Point-of-service (POS) health insurance combines several elements from both HMO and PPO plans. Similar to health maintenance organization plans, (HMO), a member is required to choose a primary care physician and seek referrals to network specialists. Like preferred provider organization insurance, (PPO), members have the choice to receive care from non-network providers but typically incur larger out-of-pocket costs for venturing outside the network.

In 2010, President Obama signed the Affordable Care Act (ACA) which puts into place health insurance reform with the purpose of providing health care access to those who are uninsured and underinsured. The goals of the law are to make health care affordable, accessible and higher quality. In 2013, open enrollment began and now that three years have passed, it is a good time to evaluate how this law impacts Ohioans (U.S. Department of Health and Human Services, 2014-a). In this paper, I will discuss health care reform in Ohio, examine positive and negative outcomes, and look at the effect of the ACA on health care economics.

On March 23, 2010 President Barack Obama introduced a new healthcare system because various Congress representatives and Obama believed our country needed a change. This new healthcare system was called the Affordable Care Act (ACA), better known as Obamacare. It is now 2016, and it is time for more changes. With a new president coming into office, Donald Trump, we can expect changes to Obamacare or an entirely new healthcare system altogether. Obamacare is costing Americans more than it was intended to (Galen Institute). This essay will explain why Obamacare needs to be improved and how to improve this healthcare system. Obamacare has two types of supporters. The first type of supporters believe there is nothing that can be done to make this healthcare system better, while the second type think there should be changes to reinforce this health care system. Opponents believe Obamacare needs to be changed or ended altogether because they claim it is not helping the American citizens. Going forward, Trump should make changes to Obamacare in order to make it stronger instead of scrapping it altogether.

In 2010, President Obama passed the Affordable Healthcare Act, also known as Obama-care. Obama care it self is over twenty thousand pages long, and it may add six point two trillion dollars to the nation’s deficits. This act was made to allow everyone the opportunity to have health insurance, specially people who can not afford insurance on their own. However, instead of helping people afford health insurance, it forces people to buy insurance that might not be affordable for them based on their income. It also makes employers pay for their employee’s health care. That expense is covered by raising the prices of goods and services.

The relationship of an HMO and its physician member is to help provide a wider range health care for its patients and a wide area of services available for its physician members. A patient must choose a primary care physician from a list of providers. The relationship with the physician provided from the HMO is in a contract that is to deliver services to their patients for a fee. There can also be a group plan which is a HMOs contract with a group of physicians to deliver services. The HMO organization compared to PPOs, a PPO is a variation of an HMO, and it features traditional insurance and managed care.

What is the Characteristics of PPO? Tends to be used in two ways. One way to apply to health care providers that contract with employers, insurance companies, union trust fund, third-party administrators, or others to provide medical care services at a reduced fee. PPO may be organized by the Providers themselves or by other organizations, such as insurance companies the Blues. Like HMO they may take the form of group practices or separate individual practices, they provide a broad array of medical services such as Physician¡¦s services, hospital care, laboratory costs¡K or they may be limited to hospitalization or physician¡¦s services.