Local MCO Model

The spreadsheet I chose to analyze was a three year Balance Sheet of Orlando Health from 2014-2016. Orlando Health is a private, not-for-profit network of community and specialty hospitals and is one of the major healthcare chains in Orlando. Orlando Health and has grown significantly since the early 2000s. It recently acquired several smaller medical facilities, partnered with the University of Florida and has been revitalizing its main campus. Additionally, it is one of the major sponsors for the Orlando City Lions, major league soccer team.

New England Health Maintenance Organization (HMO) is a regional not for profit managed care company that has its headquarters in Boston, MA, with over 500,000 enrollees within 25 different plans including Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont. A consortium of employers has shown interest in bidding on a managed care contract to be offered to the consortium’s 75,000 employees whom are locate in and around Nashua, New Hampshire. The consortium of employers includes companies such as IBM, Ford, and Prudential Insurance.

Managed care is a system of healthcare delivery that seeks to achieve efficiency by interpreting the basic functions of healthcare delivery. It employs mechanisms to control (manage) utilization of medical services and determines the price at which the services are purchased and how much the providers get paid.

In Escambia county the employment status for healthcare professionals only accounted for 16,504 of jobs (“Data USA.” 2015). Healthcare professions accounted for the second most popular job in Escambia however, the most commonly seen area of practice was retail at 22,518, healthcare at 16,504, food services at 13,128 and lastly Teaching at only 11,580 approximate jobs (“Data USA.” 2015). The major healthcare employers in Escambia county are Baptist Health Care Corporation, Delta Health Group Inc, Sacred Heart Health System Inc, Lakeview Center Inc, and West Florida Regional Medical Center INC (“Quinstree” 2017). Baptist Health Care Corporation currently has over 6,700 employee’s such as personnel and physicians at their facility INC (“LinkedIn” 2017). Delta Health Group Inc has a median average of 10,001 employees at their location (“Glassdoor” 2017). Sacred Heart System Inc has more than 4,000 employees while Lakeview Center Inc can facilitate a median range of 30,005 employees (“LinkedIn” 2017). First lets exam

In order to contain health care cost, expand access to care, and improve the nation’s health. The Affordable Care Act requires certain regulations in order to coordinate Medicare patients through Accountable Care Organizations. The first one is ACOs must have formal legal structure to receive and distribute shared saving. For example, The Centers for Medicare and Medicaid Services work with other health agencies in order to facilitate shared savings. Secondly, each ACO must have enough primary care professionals employed in order to treat their population. Third, each ACO must have agree to participate in the program for 3 years, as well as have enough information regarding health care professionals who are participating under the ACO. Moreover, ensure leadership and management structure that includes clinical and administrative systems. Promote evidence-base medicine and report the data to evaluate quality and cost measures. Lastly, the organization must prove that it is meeting the patient-centeredness criteria. An ACO must also have the ability to identify the best practices that deliver the best care and reduce cost within the organization. In addition, ACO must work with the community to provide resources to patients in order to improve he overall health of the

Seems like American Health Alliance is doing a great job coordinating their care to manage chronic conditions. When care is more organized with coordination with providers in delivering quality care, the medical outcome is usually successful with good patient experience. This encourages the patient to seek additional care when needed and to follow their treatment plan with a goal of achieving a healthier lifestyle.

Florida Hospital is a faith-based organization that provides quality good care for the Florida communities and the surroundings throughout its 22 campuses. It is part of the Adventist Health System. Florida Hospital is a non-profit hospital that is been around for over a century. This organization was created by a group of 7th-Day Adventist church members that has the desire to serve their community by bringing health and healing. They took the first step by raising funds and acquired a farmhouse that was their first health care facility. As years go by, the facility grew and improved their service. Florida Hospital is part of the Adventist Health System which operates 44 hospitals in ten states (1). Their main campus which is Florida Hospital Orlando is serving the central Florida area and the surroundings. In order to reach out better to the community and extend their care beyond the hospital doors, they develop partnership with many other companies. For example, they are affiliated with Walt Disney Company creating a special kind of Children’s Hospital. All those partnerships embrace Florida Hospital goal of providing quality health care to those in the community seeking for medical care.

(POS). There are over half of Americans with health insurance are enrolled in managed care

Throughout the early 1980’s and 1990’s the Federal Medicaid program was challenged by rapidly rising Medicaid program costs and an increasing number of uninsured population. One of the primary reasons for the overall increase in healthcare costs is the

With the increase demand in health care services in the U.S., Banner health has over 400,000 members that are currently served by their providers.in the network. Banner has shown the ability to effectively manage the health and wellness of the populations of insured members in both government and private plans. They have increasingly evolved from health system of hospitals to services through Banner Health network, Banner medical group and in 2005, with Banner- which is in Phoenix and Tucson. Banner Health network has grown to become one of the pioneers of Accountable care Organization (ACO), a branch of the Affordable care Act (ACA), and their mission is reducing the healthcare cost by forming a network with Hospitals and Doctors in giving

Florida has historically had one of the highest uninsured rates in the country (Born 2017). Despite the fact that Florida has not expanded its Medicaid program, Floridians have gained insurance coverage at greater rates than many other states. One estimate is that prior to the enactment of the ACA, approximately 21% of Florida residents lacked health insurance, and this has dropped to 13% after the ACA took effect. (Williams, 2016). Other estimates have suggested a smaller decrease of 20% to 15% (Born, 2017). Florida experienced the highest enrollment in ACA plans of any state with 1.5 million enrollees in 2016 (Williams, 2016). Increased health insurance coverage appears to have translated to increased access to medical care. Shortly

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

The Iron triangle for healthcare consists of cost, quality, and access; these three characteristics when balanced create great healthcare. Managed Care Organizations combine the three to offer consumers with care that is appropriate for their individual needs. Our book describes managed care organizations as “the cost management of healthcare services by controlling who the consumer sees and how much the service cost” (Basics of the U.S Healthcare System, Niles). Taking a look at the history prior to the Health Maintenance Organization Act of 1973 (HMO ACT of 1973) the implementation has been significant in balancing cost, and quality control. Before this Act was signed in to law by President Nixon healthcare costs were determined by fee for service. A fee for service or indemnity plan is a plan that allows the provider to determine the cost of service, this fee for service plan caused for healthcare costs to increase rapidly. An example of this would be going to the doctor with neck pain, being told to stretch then receiving a bill for 25,000 dollars. As could be understood the cost of healthcare had became a problem.

Managed care has been adopted into the government funded care organizations. Medicare managed care plans provide all coverage themselves, including basic Medicare coverage. Managed care plans cover above and beyond the basic benefits of Medicare, the size of premiums and copayments, and the decisions about paying for treatment are controlled by the managed care plan. The basic premise of managed care is that the member/patient agrees to receive care from only a specific doctors and hospitals, in exchange for reduced healthcare costs. Medicare, like other insurance companies offer plans that give Medicare beneficiaries more choices in coverage, like HMO or PPO. Managed care has been used since the mid 1990’s in order to provide healthcare to beneficiaries with serious or life long illnesses. Today, managed care has become a way for states to provide quality care to both Medicaid and Medicare patients.

Manage care plans has its advantages and disadvantages for the physicians and the consumer. In health care, it will be tricky to find a program that will be cost-effective yet deliver quality care that will be feasible for everyone. As the industry continues to develop hopefully, they will find an innovative way to improve the current system where they can service more individuals while keeping the fees low. There are several plans currently available and as time goes on new ones will become available they will have additional options for consumers. Although the sector is deeply in debt it's one that must continue to offer medical services the public; therefore, they should implement new strategies to lower the cost to make medical care cost-effective