MGOA

Pay-for-performance payment model – healthcare payment systems that offer financial rewards to providers who achieve, improve or excel their performance on specified quality of care and cost measures (HealthCare Incentives Improvement Institute, N.D.)

The client is referral to a particular medical professional depending on the clients need. Determining the most

Wu, (2014)  promote the last method and create the set of circumstances for Medicare to set ACO payments to have hospital medical staff extended components describe empirically found on declares information.

a. It is a strategy designed to provide financial incentives to physicians and hospitals to improve compliance with standards and improve outcomes and patient safety

When the pilot was conducted, Harbrecht and Latt (2012) state that the monthly care management fee, that was used to pay physician fees, was calculated by “multiplying the number of […] patients in each practice by the per member per month (PMPM) case management fee (pg. 2011).” To avoid discrepancy and to remain consistent throughout the financial process, each plan supported the same payment models, payment schedules, and administrative procedures adhering to the standards set forth by the National Committee for Quality Assurance (NCQA).

Another measure enacted by managed care organizations to control costs is limiting the amount of services a member can access. First, managed care organizations control the type of drugs that members get by offering only specific drugs that are in line with cost control measures. This means that pharmacies in the network might not offer drugs deemed to be expensive or unfriendly to the demands of the organization. Secondly, organizations limit the doctors that members can have access to. If one’s personal doctor is not in the list of doctors provided by the organization, a member is forced to switch by choosing one from the organization’s listed doctors. Managed care organizations also control costs by limiting the number of days a member is admitted in the hospital. Doctors are encouraged to discharge patients faster in order to reduce care costs.

There are important advantages to capitation which should be addressed as well as the disadvantages. MCO’s have to negotiate and contract with physicians carefully and strategically. As stated in the Module 3 PowerPoint lecture notes, a number of factors will determine which reimbursement approach is used such as amount of care competition and density of PCP’s in a given geographic area, (Orji, 2015, PowerPoint slide 10). Depending on the plan, the physician gets paid and costs do fluctuate from different regions. Beneficial ways of capitation which are they have an arrangement when specific services that

They are more likely to be compensated in part on the basis of quality than physicians in small or medium-sized group practices. Financial incentives that are facing with doctors and hospitals push up cost. But not all doctors have a financial incentive to over treat patients. In particular, some hospitals are owned and operated by health maintenance organization insurance companies. At these hospitals doctors are salaried employees who receive no financial rewards for their performance. Physicians are paid before services with set amount of money for each patient. The amount that is rewarded determines by the service that is giving for each patient. These charges are developed by using general expenses and normal operation of services. This proportion is a capitation security pool. This funding cannot be compensated to doctors until the end of the economic year. The only method doctors will get compensated or uncompensated is for their medical services; only if the procedure does monetarily adequately or inadequately expenses will

An MCO is a health care network that connects providers, patients and health insurance to decrease price of care and increase quality of care in a variety of plans. MCOs have a multitude of drawbacks to go with their multitude of plans. Today, three of the drawbacks will be addressed. The first drawback is the plan determines what healthcare providers the patients can see

In chapter 4, I learned about managed care organizations (MCOs), preferred provider organization (PPOs), and health maintenance organizations (HMOs). In PPO there is a list of in-network providers that patients are allowed to see but pay a lot more if they see a physician that is not on the list. In a HMO patients are only allowed to see physicians that are employed by them and may not see anyone else. There are a variety of methods to pay providers for healthcare services. Two of them are widely known as capitation and per diagnosis. Under capitation, organizations receive a fixed amount of money each month regardless of use. In per diagnosis, organizations are paid based on the diagnosis of the patient. The chapter also explained cost shifting

(Gleason, Ridic & Ridic, 2012). Because of the structure of this system, co-payments required by the consumer are kept minimal, choice of physicians is essentially unlimited, and physicians are reimbursed a set fee for their services which is periodically negotiated between the ministry and the provincial medical associations (Gleason et al., 2012). In the U.S. physician choice is dictated by the specific plan the person is covered under and its participating providers, co-pays can vary, there are deductibles that must be met prior to coverage, and prices for service and reimbursements are determined by the payers such as Medicare and Medicaid. Insurance companies may also have third party payers that further dictate how much the physician is reimbursed and what they can collect for their services with no incentive for its decisions to benefit the patient or the physician (Shi & Singh, 2015). Systems that are centralized face limits based on budget, these restrictions are evident when it comes to medical technology and specialized services, because the U.S. is mainly private, we have wider availability of specialized services and advanced technology (Shi & Singh, 2015). The four most notable types of coverage in the U.S. are the managed care organizations (MCO’s): The Health Maintenance Organization (HMO) and the Preferred Provider Organization (PPO), and the public health insurance Medicare and

Under the plans listed above, the managed care plans (HMO, PPO, and POS) offer the best methods of containing costs while encouraging accountability and patient outcomes. Each plan has limitations because of the structure of the program. For example, HMOs can manage costs and encourage accountability, but may restrict patient outcomes because of the organizational acceptable care plans to treat certain diseases. HMOs manage care by utilizing general care which may or may not treat the specific disease that the patient is suffering from and limits the types of acceptable pharmacological treatment for the disease. This can be frustrating for both the provider and the patient because of the limitations placed by the

The purpose for the organization Walgreens is to stay put in a dynamic, self-motivated and energetic business environment. Walgreens is a successful business looking to progress overall presentation and place the company for potential expansion. In order for this to follow through, a total rewards program needs to be created. The incentives and compensation plan must connect with the goals of the organization. A solid rewards program will build motivation in the work place. As the text states, “The notions that rewards are means to motivate employees assuming that the rewards are distributed fairly. Rewards seem to be part of many different perspectives in motivation

This can be structured to become a majority of the income source and molded to ensure the practice is receiving its maximum P4P incentives. Incentive payments may be tied to measures such as well visits per day, timely note completion, and reduced percentage of eligible well-care not performed. Additional measures may be established such as patient satisfaction, or other quality metrics as the practice expands its quality metrics capabilities. The most important aspect of the compensation package is that it is mutually beneficial to the physician and the

On the other hand, another control system the organization is their rewarding strategy; as they link their performance and abilities to meet goals and targets to pay raise and promotion.