For the last five weeks research has been done on Kaiser Permanente, an organization that contains Kaiser Foundation Health Plan, Kaiser Foundation Hospitals and Permanente Medical Groups in eight regions. Since its inception in 1945, Kaiser Permanente has become the largest not-for-profit, integrated health care delivery system in the United States, serving 8.6 million members in eight regions: Northern and Southern California, Colorado, Georgia, Hawaii, the Mid-Atlantic States, Ohio, and the Northwest. About three quarters of the members are in California, the organization’s birthplace. It is the largest nonprofit integrated health care delivery system in the United States. Its mission is to provide affordable, high-quality health care services to improve the health of their members and the communities they serve. For the purpose of this research, focus will be on Northern California in a randomly selected hospital.
More and more people with medical insurance are relying on the health care system as new technologies and treatments become available. This leads to a grater number of claims for payment by insurance companies, the costs of which are passed back to health care consumers. The baby-boom generation is entering its peak health-care using period. Over eighty million Americans will turn 50 in the next 10 years. The cost of providing heath care for these individuals will be staggering
Kaiser Permanente is a managed care facility that provides services across the health care continuum. Over the years the organization has continually made efforts toward improvements since it was first founded in 1945. These improvements generate a series of successes that set Kaiser apart from similar organizations. But, just as any health care delivery system, Kaiser has faced challenges in the past, present and may continue to do so in the future. In this paper I will explain what attributes to the success of Kaiser Permanente and some of the challenges they face.
As a managed care organization Kaiser Permanente has served as a model for informational healthcare systems and the recent demand for affordable care has prompted the organization to lower cost in services without hindering the quality of care. Kaiser Permanente has integrated a system in which the organization assumes all financial risk and a bundled enrollment fee for service strategy. What makes Kaiser Permanente unique from other HMOs is their accountability for quality, utilization management, financial risk, and business strategies (Kaiser Permanente, 2009).
Since the advent of health insurance in the 1950s, there have been many models of care that are come to the scene in an attempt to both control cost of care and improve quality of care. Insurance models came into being because the fee for service model used until then was proving to increase cost of healthcare without any measure of quality of services and care provided. Health insurance models have evolved from the basic hospital offered insurance to employer sponsored coverage plans. The US health system is broken both financially and quality wise with more than 20% of gross domestic product being spent on healthcare (Blackstone, 2016).
As you learn about health care delivery in the United States, it is important to understand the various models of health insurance to develop a working knowledge as you progress through the course. The following matrix is designed to help you develop that knowledge and assist you in understanding how health care is financed and how health insurance influences patients and providers as important foundational information for your role as a future health care worker. Fill in the following matrix. Each box must contain responses between 50 and 100 words using complete sentences.
There are four different levels of insurance that the consumer has the option to choose from. The Bronze level is the cheapest and will provide 60% of benefits under the health plan. Next, is the Silver level that will provide 70% of benefits, and the cost is more expensive. Next, is the Gold level that provides 80 % of benefits, and costs is still more expensive. The Platinum level is the highest, which provides 90% of benefits, and is the most expensive of all the health plans. “Under ObamaCare, your primary point of contact regarding health insurance and health care services will be your state health exchange” (Taylor 40). Medicaid services will be expanded to consumers with incomes less than $14,000 person annually or family’s income less than $29,000 annually. At the market place insurance companies will compete against one another, which will benefit the consumer. The insurance companies that charge higher rates than their competitors will be driven out of business. The government will provide tax credits to consumers that have an annual income from 14,000 to
Closing out the meeting was John Connolly who serves as Associate Director of Insure the Uninsured. Connolly detailed the Covered California healthcare exchange as a commercial insurance provider. Connolly spent the majority of his time speaking addressing the improvements to coverage, and eligibility changes to applicable California residents. Making a repeated and substantial effort to state how the commercial insurance exchange would work, Connolly showed the various healthcare providers that would be available to certain individuals, and an estimation of the average cost per provider. The most significant aspect of Connolly’s presentation was his outline of the new health insurance plan tier levels, ranging from “Bronze” to “Platinum”. Bronze tier coverage represented the tier with the smallest amount of payment made by the plan and highest amount of payment made by the consumer, and Platinum tier coverage representing the highest amount of payment made by the plan and lowest amount paid by consumer.
Regrettably, there is a downside of High Deductible Health Plans (HDHP), and that is the likelihood of higher expense later on if there is any cataclysmic medical issue with you or your family. With a High Deductible Health Insurance Plan, you run the risk of having higher out-of-pocket expenses. For example, a major medical issue warrant surgery, you would have to pay your deductible before the insurance company pays anything. This may cause you to forgo crucial health care needs; due to the high-deductible and out-of-pocket expenses you would occur. Lastly, if your monthly out-of-pocket expenses are high, this will enable you to have an advantageous use of your health savings account (HSA).
Unit 2 AssignmentKelley WhitcombKaplan UniversityHI215-01: Reimbursement MethodologiesProfessor Kathleen SobelJuly 20, 2015Medicaid is one of the biggest insurance plans you can get in any state. In the state of Indiana, it is based off of your income. There is a certain amount (income) you have to make to determine if you will receive Medicaid or Healthy Indiana Plan (HIP). HIP is still a form of Medicaid, but you would have to pay monthly cost for it and have certain set of co-pays for certain services that is needed. HIP Plus is the recommended plan for members as it provides health coverage for a low, predictable monthly cost. HIP Plus also covers dental and vision services. If you do not pay your monthly payment you can be removed from
Middle-income earners, those who “had incomes ranging from about $42,000 to $125,000 in 2014” (Fry & Kochhar, 2016), are often hit the hardest by what one could deem a coverage gap. This gap exists because many middle-income households do not qualify for Medicaid or sufficient subsidies and cannot afford to purchase plans in the top two, Gold and Platinum, insurance tiers. They are instead
state that the individual deductible has to be under 1250, which oddly enough is just slightly under the 1300 required to be HSA eligible. That $50 difference has two major effects on the individuals in the silver plans one you will not be able to buy what is considered an HSA eligible plan, they will not be available deftly not in 2018 likely not in 2017. So, you be paying more in premiums for your health insurance and you will no longer be eligible for contributing to an HSA account. This is a significant change in something we really need to start planning for right
Today’s market demands organizations to have a strategic plan. The purpose of the strategic plan describes where the organization wants their organization to go. A strategic plan is a document used to communicate goals, and the actions needed to achieve those goals. In order to remain competitive every organization needs to innovate to stay ahead of the competition. They need to develop new products and services with increasing frequency. The design of these new products and services must meet, or exceed, customer expectations and at the same time, they must generate an acceptable financial return for the organization. However, any business that does not realize the importance of developing new products will not last very long as a consequence
The United States (U.S.) has a multitude of options for health care coverage. People have the option for private or public coverage. One example of public coverage is Medicaid and an example of private coverage is Blue Cross and Blue Shield (HCSC, 2015). There are many differences between each health care option, the biggest difference is the price you are paying. This paper will discuss the differences between private and public health insurances as well as the cost for each.
Health insurance coverage is a necessity used to decrease the cost of health care expense. Many individuals require some version of health care coverage and depending on the situation, every coverage has its own requirements. In the state of New Mexico, a discussion of the various health insurance coverages based on age, employment, and status is being compared along the contributions made to towards the premiums.