Nordstrom Health Care Case Study

The consumer driven health plan (CDHP) is a combination plan, one with a high deductible plan and one with a tax-preferred savings account plan directed by the patient. The plans work together for the patient with the high deductible for major losses and the savings accounts for out of pocket expense or non-covered expenses. With the CDHP, patients are more inclined to research their medical care in order to make informed decisions (Valerius, Bayes, Newby, Seggern , 2008).

Recently, a Consumer Driven Health Plan (CDHP), was created. There are many variables to a CDHP, such as benefits covered and coinsurance amounts, however there is one thing that all CDHP’s have in common – a high deductible. By having a high deductible, such as $1,200, it forces the plan participant to think about the medical services they are seeking. Do they really have to go to the emergency room for that cough or can they go to urgent care, or better yet, their physician the next day. When the plan

Example: 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.

When you look over your health insurance choices this year, there will be an option to select high-deductible health plan on the menu. These types of healthcare plans are increasingly becoming popular amongst healthcare seekers and consumers. So, why would anyone choose an insurance policy with greater out-of-pocket costs? Plans with higher deductibles typically have lower premiums, so you'll keep more of your paycheck. A High Deductible Health Plan (HDHP) is a plan that has a higher annual deductible than a typical health insurance plan; maximum limit on the sum of the annual deductible and out-of-pocket medical expenses that an enrollee must pay for covered expenses. The out-of-pocket expenses for a High Deductible Health Plan are

HMOs: The Health Care of the Beast 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

I currently work for a hospital which is part of an academic medical center. It offers 3 health plan options to choose from. The first is the hospitals own medical plan which which is has features of an EPO, and can be categorized as a CDHP (Consumer Driven Health Plan). It has a higher monthly cost, but lower out-of-pocket costs when care is needed. It has a large network of providers including the hospital, and a network of providers who have partnered with the institution. You are not required to have a PCP, but it is recommended, you must use in-network providers, it has a HIA (Health Incentive Account) with wellness incentive funds available for members. The second is a POS plan from one of the larger Insurance companies with 2 tiers of in-network providers, lowest monthly cost, but a higher out-of-pocket cost when care is needed, until you meet the annual deductible amount. This has a Health Savings Account (HSA) attached, and you can have tax deductible contributions go to the fund, and wellness incentives funds can be deposited into the HSA. The third is an HMO plan with the highest monthly cost, but a lower out-of-pocket cost compared to the POS plan when care is needed. It also has an HIA attached as well.

The dissatisfaction with managed care for some consumers has resulted in the change of some insurance plans altogether. "Significant numbers of health plans have reduced their reliance on managed care tools at a time when health insurance premiums have returned to double digit rates of growth in many markets. Faced with fewer instruments for curbing utilization and constraining provider payments, health plans have attempted to mitigate premium growth by shifting costs to consumers. These developments promise to lighten the administrative and financial burdens that managed care has imposes on physicians and hospitals, while leading consumers to

High Deductible Health Plans: Their Growing Popularity and Impact on Consumers The changing landscape of the current health care system in the United States has caused new methods of insurance to gain in popularity. The High-deductible health plan (HDHP) is increasingly favored by employers and offered on the exchanges created under the Affordable Care Act (ACA). According to the Centers for Medicare & Medicaid Services (CMS) a HDHP is “a plan that features higher deductibles than traditional insurance plans. High deductible health plans (HDHPs) can be combined with a health savings account or a health reimbursement arrangement” (2015). In the HDHPs premiums are lower, offset by the higher deductible. The health reimbursement arrangement (HRA) the employer contributes to a fund for medical expenses while in the health savings account (HSA) which employees pay into but is not required of the employer (Shi & Singh, 2012, p. 208). The growing popularity of these plans is important as it will have effects on the healthcare costs as well as how consumers use healthcare.

The HMO could oversee and approve physician decisions such as whether to admit a patient, how long to keep the patient in the hospital, and whether to order expensive diagnostic tests for the patient, all of which heretofore had been made autonomously by physicians. The HMO “managed” care, with the goal of limiting high costs due to overutilization, without compromising patient outcomes. In the next three decades, health insurance plans adopted tactics introduced by the HMO model to limit expenditures and health care use. Managed care grew to encompass 97% of the employer-sponsored health insurance market, which represents approximately half of all insured Americans (Bradley and Taylor, 2013). Since the managed care systems lowered costs, Medicare and Medicaid programs also began to increase their managed care tactics, instituting greater control over physician and hospital decision-making, to further rationalize their spending. Thus, managed care efforts began to slow the acceleration of health care costs during the 1990’s; however, this attenuation could not be sustained. Public complaints of overly harsh rationing by managed care companies reduced their popularity in the employer insurance market and cost acceleration resumed in the early

First, we should discuss the major problem The problem with this is that if the premiums and co pays are too expensive for the working consumer to afford, then they will choose not to get seen until it is an emergency. Then, be forced to be in medical debt, or claim bankruptcy.

Nordstrom (Type of Retailer/Characteristics) Nordstrom’s is classified as one of the biggest U.S. department stores. Along with Sears, Macy’s, and JC Penny’s, Nordstrom manages each department in their stores as an individual buying center. Every group functions separately from one another, and is administered by a buyer who is in charge of all varieties and styles of merchandise sold. Promotions that can be used in the stores are included, as well. “The company has also benefited from a new computerized inventory system that gives buyers and salespeople the necessary data to make smarter decisions about what is needed in the stores—and what isn’t.” (Lamb, Hair, McDaniel 569). This new and improved system allows the department store to market a greater amount of full priced items, which ultimately increase sales. The buyer is also able to easily determine what items to obtain and exhibit in the store by using this system.

Managed care's character in healthcare could modification. Increasing numbers of employers are transfer workers to high-deductible health plans, moving more costs to employees.

Running head: WEEKLY ASSIGNMENT: ASSIGNMENT SIX Weekly Assignment: Assignment Six Rachel Edwards Concordia University Wisconsin Professor Erik Hollander MBA 685 April 18, 2016 Introduction The goal of the current American health care system is centered around making a profit. As discussed in both Health Care Meltdown and How We Do Harm, many doctors today are making a profit on over diagnosing and over charging, leaving patients with undesired care and little money. This system is not only straining practitioners and over treating patients, but drastically increasing the cost of care in America. As discussed in detail in each of the books, there are steps that can be taken to increase access to health care while decreasing expenditure.

You have made a lot of good points about the impact of deductible and co-payment on patients seeking health care. Did you know that 51.1% of low-income families reported have to delay or forgo treatment due to cost of care compared to 34.8% of higher income families? Based on this

With so many insurance companies and employers going to High Deductible Health Plans (HDHP), it would be beneficial to patients if the cost of healthcare was lower. According to Gapenski & Pink (2011), “Most employers pay some (or all) of the HDHP premium but require the employee to fund the HSA.” HSA’s were created so that anyone that participates in the program can use the money set aside to help pay for certain medical cost, dental care, vision care, some medical supplies and some over the counter drugs. I believe that HSA’s will have an impact on healthcare cost for the following reasons: