Medtronic Health Insurance Case Study

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.

The next factor to consider is competitive position and healthcare firms can substantially ensure higher quality of care when pricing there products and services at an increased level. Aside from pricing, cost is another major aspect since it can drastically affect a company’s competitive position. A hard investment would involve a MRI device that insurance companies or healthcare organizations could reimburse the office at a higher rate for providing the patients of improved cost-efficient results. As a result, such benefits accrue primarily from savings in drug expenditures, improved utilization of radiology tests, better capture of charges, and decreased billing errors, (Wang et al., 2003). Physician providers are always in competition with the latest and greatest technology, EMR system, and most effective medication for patients.

This week I began my 6-week internship at Blue Cross Blue Shield of Nebraska (BCBSNE). The first day was a common orientation for all new employees, internally denoted to as the “onboarding process” where all employees are told they matter. This full-day session communicates the core mission, vision and goals of BCBSNE, organizational structure, operating objectives, and workplace culture. BCBSNE is a not-for-profit health insurance company that is focused on collaboration to find the best solution for their customers; in other words, they are customer-focused. Since the implementation of the Affordable Care Act (ACA), many changes to the health insurance market required a change in the organizational structure and culture of BCBSNE. Through partnerships with providers, the goals of BCBSNE are to be responsive, accountable, minimize errors, and decrease costs – all components of the ACA. BCBSNE has strategically aligned their goals to those of the government-mandated goals, and implemented them at all levels of the organization, making them competitive in the health insurance market. I found this very fascinating: I was very excited after day one!

While our understanding has evolved with respect to certain advantages of MCO’s, our understanding of the disadvantages has also grown. This analysis will evaluate the use of MCO’s as a gatekeeper to controlling health care cost and offerings. It will evaluate the advantage MCO’s provide in a rapidly growing market due to the aging of baby boomers. The analysis will evaluate disadvantages that can arise with relying on MCO’s. These disadvantages work against the insurance company forcing a polarizing balance between how much control the MCO should retain over recommendation and provision of services.

Many people are concerned about rising health care costs. In reaction to this, some individuals and companies are gravitating toward the assumed lower prices of Health Maintenance Organization (HMO) health plans. HMOs spend billions of dollars each year advertising their low cost services. While these savings look good on paper, there are many pages of small print. The explanation after the asterisk indicates that not only do the HMOs lack lower costs, but they also short-change the patient in quality care. Much of the money spent on premiums goes directly into the pockets of stockholders and less is then available for

In a world of budget cut and layoffs, medical corporations face new and different challenges in addition to helping and healing patients. I used to work as a medical biller in a physician’s office for five years and I experienced how difficult for the health care providers to get reimbursed. The government and the insurance companies have been limiting the budget towards the health care services. This action also affects the hospitals greatly because Centers for Medicare & Medicaid Services (CMS) and some policymakers have requested the hospitals to reduce the

“a) Contracts that explicitly detail the responsibilities of employers as purchasers with insurance, managed care, and hospitals and physician groups as suppliers, b) Information to support the management of purchasing activities, c) Quality management to drive continuous improvement in the process of healthcare purchasing and in the delivery of healthcare services, d) Incentives to encourage and reward consumers, and e) Education to assist employees become better healthcare consumers” (p. 352).

One area that has contributed to the rise of healthcare costs are the varieties of healthcare services offered to the patient. Competition between providers has caused physicians and hospitals to offer the most current healthcare technologies and modern, eye-catching settings in order to attract and retain clients (Shi & Singh, 2015). Reimbursements for costly procedures and hospital services have been compensated at a higher rate which has also supported the expansion of hospital and specialty procedure settings (Schroeder & Frist, 2013). Renovations of the physical settings and the acquisition of expensive technologies have elevated healthcare services prices to encompass the additional costs of providing high technical services and attracting clients and cause the over-utilization of expensive treatments.

Competition between providers has caused physicians and hospitals to offer the most current healthcare technologies and modern, eye-catching settings has contributed to increasing healthcare costs, as well as providing unwarranted highly technical services (Shi & Singh, 2015). Renovations of the physical settings and the acquisition of expensive technologies elevated healthcare services prices to cover the additional costs of providing high technical services and attracting clients.

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

With the continued transformation of the healthcare system, an increased emphasis on consumerism and quality-based reimbursement will be observed. This could lead to challenges for all managed care stakeholders. One example of an industry change that might occur is that patients’ out-of-pocket costs could increase. The cost of healthcare continues to rise faster than inflation, generating increased incentives for insurance companies to offer plans with high deductibles and small networks. In the article “The Top Changes MCOs Should Expect in 2016” Joel Brill (2015) states that:

The next step was to develop a part-time employee healthcare benefit package for their employees. Due to the rising cost of private healthcare it was important that for these part-time employees the package was affordable. REI developed an attractive healthcare package for their part-timers, “known internally as the PaTH (Part-Time Healthcare) plan, will each (employee) pan in individual medical/dental monthly premium of approximately $41 with a $150 deductible” (Business Wire, 2005). This affordable healthcare provided part-time employees a healthy safety net. Next, REI observed positive

As it relates to the textbook, this describes some of the scope of the hospitals; which refers to the range of activities which the firm performs internally, the breadth of its product and service offerings, the extent of its geographic market and its mix of businesses. But unlike with the electric company, no regulator caps hospital profits. To the extent that author Steven Brill found any consistency among hospital charge-master practices, this is one of them: hospitals routinely seem to charge 2V2 times what expensive implantable devices cost them, which produces that 150% profit margin.

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.

Healthcare professionals have been saying that the healthcare in the U.S. is the most expensive when compared to the rest of world, however rank very poorly between other industrialized countries in healthcare outcomes. This is a very complicated problem and an approach that Walmart can develop and tackle these challenges by opening a Walmart Care Clinic for customers and associates, motivated on improving access, strengthening quality and lowering healthcare costs. The Walmart Care Clinic model will concentrate on teamwork, organization and connecting customers and healthcare