Health Plan Survey Paper

The types of managed care are differentiated by definition, operation, structure, and information needs. `HMOs were the most common type of MCO until commercial insurance companies developed PPOs to compete with HMOs' (Douglas, 2003, p.331). `HMOs are business entities that either arrange for or provide health services to an enrolled population after prepayment of a fixed sum of money, called a premium' (Peden, 1998, p.78). There are three characteristics that an HMO must have. The first is a health care financing and delivery system that provides services for members in a particular geographic area. Second, is ensured access to a complete range of health care services, health maintenance, treatment, and routine checkups. Last, health care must be obtained from voluntary personnel that participate in the HMO. The five HMO models related to the participating physicians are the Staff

The Hospital Consumer Assessment of Healthcare Providers (HCAHPS) began in 2006 with a 27 question survey that is distributed to discharged patients. This survey process was originally designed to help patients compare hospitals in their area to be able to make an informed choice for their healthcare needs. In January 2013, five additional questions were added to the survey. Beginning this year, Medicare reimbursement rates to a hospital are tied to the hospital’s patient satisfaction scores. Therefore, hospitals are continually looking for ways to improve

The HCAHPS survey is administered to a random group of adult patients across medical conditions between two days and six weeks after discharge; the survey is not restricted to Medicare/Medicaid beneficiaries. HCAHPS can be executed in four different modes: mail, telephone, mail with telephone follow-up, or active interactive voice recognition (IVR). The survey 's results can be found in the current HCAHPS Quality Assurance Guidelines, which is available on the official HCAHPS website, www.hcahpsonline.org.

Healthcare is in a constant state of change with movements that impact rates, access and quality of care. Hospitals have become more competitive due to the rising cost of care delivery and the reduction in reimbursement from payers. This causes difficulty in delivering quality care to all patients, which is being measured by mandated patient perception surveys, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). HCAHPS scores are part of value

Health care plans are policies created to aid the patients in accessing medical services in form of insurance to cover the expenses incurred during treatment and hospital care. In analyzing the options given by two major health care plans elaboration will be based on two major insurance schemes namely indemnity insurance plan and Managed Care plan. All these vary yet with a common aim of providing medical services to the patients. In order for the analysis, consideration will be based on the costs and the coverage. These two plans differ in many important ways, more so in regard to how the services are offered, the way to obtain special care and the cost of care after recovery. Despite the diversities, the two care types share many

Each state has their own policies for Medicaid eligibility, services and payments. Medicaid plans have three eligibility groups such as categorically needy, medically needy and special groups. Children's Health Insurance Program (CHIP) is a program that offers health insurance coverage for uninsured children under Medicaid. If Medicaid does not cover a service, the patient may be billed if the following conditions have been met such as the physician informed the patient before the service was performed that the procedure was not covered by Medicaid and if the patient has signed an Advance beneficiary Notice form. However, there are also conditions where the patient cannot be billed if necessary preauthorization was not obtained or service

HMOs are usually the least expensive health plans, offer predictable costs for health care, the least administrative paperwork, and cover preventive care (Barsukiewicz, Raffel, & Raffel, 2010). However, HMOs also restrict direct access to specialists by requiring referrals by a PCP, requiring patients to see a provider in the HMO network, and often not covering more costly procedures or care options, because care is managed to control excessive or unnecessary care. Providers gain if they provide less care (Austin & Wetle, 2012). This incentive could affect patient-provider trust.

I have been asked by Cooper-Pearson to research different medical insurance plans that they could consider as one of their selected insurance programs for their marketing company. My goal is to provide them with enough details in order for the company to make an informed decision as to which program they would like to consider. This information will allow them to provide their employees with an effective compensation package that is both affordable and desirable and I believe that once an attractive compensation plan is in place; we should expect the retention rate of the company to improve and the recruitment of quality employees to increase as well. First I will start by demonstrating the comparison and contrast between an HMO plan and a

For insured small group and individual market plans, the health insurance issuer should use data at the “plan” level (as opposed to the “product” level) to perform the substantially all and

The whole world has issues with healthcare and how to provide care for all their citizens. The United States is currently in the process of making changes to its healthcare system. There are currently multiple types of health insurance in the United States. Today, I will address the health care insurance I have, its products, source of my insurance, my out-of-pocket expenses, the level of coverage I receive with my plan, the major limitations to my coverage, and the process of receiving needed care, needed care in my plan including exams, how to get to a specialist if needed and the process for non-emergency care.

Today’s options for medical healthcare is a wide stream business that has took off when healthcare became a hot topic on Capitol Hill. Thru the joining of American Association of Health Plans and Health Insurance Association of America a new trade association was created. That medical health insurance is called The America’s Health Insurance Plans (AHIP) it’s currently representing the health insurance industry. Like such a large number of other focused medicinal medical coverage AHIP is one numerous spots that a person will realize that they have an organization that pays special mind to their wellbeing. AHIP has exceptionally solid perspectives on why individual ought to end up becoming a member. They

If you get health services from a doctor or hospital that is not in the preferred network (known as going "out-of-network") you will pay a higher amount - perhaps a coinsurance of 20% or more. And, you will need to pay the doctor directly and file a claim with the PPO to get reimbursed.

Healthcare Effectiveness Data and Information Set (HEDIS) is a tool that uses a comprehensive set of standardized performance measures which provide reliable comparisons of health care plans for purchasers and consumers. The tool is used by most HMO and PPO plans to measure important dimensions of care. The National Committee for Quality Assurance (NCQA) states that health plans also use HEDIS results themselves to see where they need to focus their improvement efforts (National Committee for Quality Assurance [NCQA], n.d.). Consumers benefit from HEDIS data through the State of Health Care Quality report, which provides a summary of performance of the nation’s health care system (NCQA, 2016). Purchasers and consumers can view

Health Choice Insurance Co. is a managed care organization which provides health plans beneficial for you, your family or your company. Although the company is based out of Arizona, it is affiliated to IASIS which has its presence in Utah, Texas, Nevada, Louisiana, Colorado, Florida, Arkansas and Arizona. Being a subsidiary of IASIS, Health Choice Insurance Co. provides Medicare as well as Medicaid services in Utah and Arizona area. Being relatively new in this industry, from 1998 Health Choice Insurance Co. have been successful in expanding their network to 19 acute care units and one behavioral hospital in 8 different states such as

My health care choice is located near downtown Saint Paul, MN. Regions Hospital is one of the convenient Hospitals in the metro area of Minnesota. The Hospital was made in 1872 by the Ramsey county. It was first named County Hospital in 1923. Then it was changed the name to Acker Hospital. Doctor Arthur Acker was superintendent. In 1965, the location was moved from university Avenue to Jackson St. In 1977, it was named Regions Hospital. It is now much bigger than before, and not they have the number one trauma team for pediatric and adults. Regions Hospital is a private, nonprofit hospital with a special program like heart center, cancer; behavior health, birth center; burn units, emergency department, and trauma center. Regions hospital’s