For this discussion, assume the role of a healthcare administrator, and make a recommendation for or against a managed care plan. Should your organization adopt this plan? Support your recommendation with the positive and negative aspects of the plan.
When responding to your classmates, analyze their rationale and constructively critique the viability of their recommendations. Based on their support and explanation, would you follow their recommendation?
This discussion will assist you in preparing for Milestone Three.
Attached are discussion one and two please respond to them accordingly.Antoinette Tuddles
As a healthcare administrator, I would recommend the utilization of a managed care plan. These are health plans that manage care by integrating the financing and delivery of specific healthcare services, such as an HMO (Casto, 2018). My organization should adopt this plan because its goal is to control costs and provide quality and affordable healthcare (Casto, 2018).
Some of the advantages of a managed care plan are it lowers the costs of health care for those who have access, people can seek out care from within the network of providers, and physicians can treat the whole person with a Primary Care Physician (PCP), who acts as a gatekeeper (Casto, 2018). The gatekeeper’s role is to control costs. Case management coordinates patient care for the most complex and high-cost cases. Providers must undergo accreditation processes to ensure that health care is provided effectively. Also, prescription management is a cost-control measure where providers may order generic brands of drugs as opposed to their more expensive brand name counterparts (Gaille, 2017). Providers are paid via capitation and can track revenue a bit easier through this method of payment. There are also incentives provided when meeting goals of cost-efficiency.
Some of the disadvantages of the managed care plan are that networks can become very busy based on the population it serves, causing long wait times to get an appointment. This can be a dissatisfier for patients and can result in not meeting specific incentives. Various other penalties can be accessed for not meeting incentive targets. There are also other disadvantages such as the increased costs of unapproved care, which results in collection efforts that may not be met (Kimuyu, 2018).
The advantages and disadvantages of managed care plans are that it can be an effective system of health care management. However, it must be proactively managed to remain beneficial (Gaille, 2017).Wannie Brown
Managed care provides reasonably good healthcare and can merge clinical, financial, and administrative processes to administer availability, costs, and the value of healthcare (Casto & Forrestal, 2015). “Managed care organizations (MCOs) have the goal of trying to manage care while offering enrollees a variety of plans that include medical services such as behavioral health, prenatal and various testing. One benefit of an MCO is the financial incentive to both the patient and the organization. PPO Still has the fee-for-service aspects, which is a benefit for providers. Patients receive quality healthcare at reasonable costs while following the rules of the MCO in choosing a primary care physician (PCP) within the MCO’s network as well as obtaining the appropriate referral for additional testing and services” (Casto & Forrestal, 2015).
As an healthcare administrator, I would make recommendations for Preferred Provider Organization (PPO) because they are best in the hospital settings being that they are able to cover large groups of members and provide healthcare services (Casto & Forrestal, 2015). “PPO is an appealing plan due to its many positive aspects of being decentralized, having flexibility in choices for members, negotiated fees, financial incentives, no capitation, limited financial risks for the providers, and no regulation under the HMO requirements” (Casto & Forrestal, 2015). PPO gives the option of healthcare services at a reduced or fixed rate. It provides flexibility of using healthcare services of any provider, or hospital that is in the plan.
Although PPO is good, there are also downside to it which is the negative characteristics of restriction in certain things. With PPO, members have limitation to providers that are in-network, if a patient use a service that is out of network, the bill may not be covered. There is a great uncertainty in referrals and high rates in reimburse.
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