Brittnie Bennettas A Healthcare Administrator There Are A Few Managed ✓ Solved

Brittnie Bennett As a healthcare administrator, there are a few managed care plans to choose from for the organization. Keeping in mind both the patient satisfaction from the plan, but also thinking about how the provider and facility will be treated with the specific plan. The Health Maintenance Organization, or the HMO was first initiated to help control healthcare costs (Casto 2018). My recommendation would be that the organization adopt the HMO plan because I think that it represents both the patients and the providers well. Some HMOs hire the provider and own the hospitals, and others have contracts with the providers to provide services (Casto 2018).

The negotiated payment rates in the contract with these providers are discounted, but the providers don't mind that knowing that there is a certainty of referrals and income (Casto 2018). Even though there are four basic HMO's, they all share certain characteristics. They are an organized system of healthcare delivery to a certain geographic area, and have voluntarily enrolled patients (Casto 2018). They also have established a set of basic health maintenance and treatment services and have multiple payment options for enrollees (Casto 2018). HMOs emphasize preventative care, they believe that in the long run, preventative care will cost them less then the care and treatment a patient would need for a chronic illness.

I would definitely recommend my organization adopt HMO's and the beliefs behind the plan. As the role of a healthcare administrator, it’s important to consider all options when thinking about managed care plans and whether or not those plans have better outcomes than the traditional fee-for-service plans. A vital goal is to provide access to care for all patients and ultimately improve our organization's quality of care. However, there are a few factors to consider when looking at managed care plans—for instance, economic incentives. Managed-care plans like HMO plans can have cost risk if services or payment exceed what the plan’s contract with the state consisted of.

A positive that comes with capitation is that providers are encouraged to keep all patients who are enrolled healthy and updated with all tests and appointments to keep the cost low. As a healthcare administrator, I would recommend being for managed care plans because HMOs focus on providing the highest quality of care to patients. To accomplish the goal of delivering high-quality care to our patients, the four main principles from MCO should be the main focus. The four main principles that perform quality improvements are selecting providers, the health of populations, the use of care management tools, and the maintenance of participation in quality improvement programs. The providers' selection should be based on the geographic area, the population, the services of which the provider is credited, and the provider’s online reviews.

Health outcomes are also a priority when looking at managed care plans. Programs such as wellness management, preventive health, access to home health, and hospitals are a positive insight when looking at our members' health care services. Care management tools are also a positive component - care coordination, case studies, disease management are all tools that help with how accessible healthcare is to our population. Lastly, the quality assessments focus on all aspects of finding improvements. For example, Casta states that “as part of clinical improvements, surveys are taken to obtain feedback on issues such as the plan’s strengths and weaknesses, the needs of customers, and the satisfaction of clinical and administrative care†(2018).

Surveys are an important element when looking at how to improve the quality of care. Surveys from patients, employees, physicians, and even disenrolled members help measure ways to control costs and find the best healthcare plans.

Paper for above instructions

Managed Care Plans: Advantages of Health Maintenance Organizations in Healthcare Administration

Managed care plans have become a significant part of the healthcare landscape, particularly in the United States. As healthcare administrators, managing the various options available and understanding their implications on both patient care and provider satisfaction is critical. This paper argues in favor of adopting Health Maintenance Organizations (HMOs) within the healthcare system, due to their well-documented advantages regarding cost control, quality of care, and preventive services.

Introduction to Health Maintenance Organizations (HMOs)

Health Maintenance Organizations were introduced as a way to control the rising costs of healthcare (Casto, 2018). HMOs operate on a managed care model where healthcare providers are contracted to deliver a wide range of services to enrolled patients at a reduced cost. This model emphasizes a unified approach to health care, focusing on wellness and preventive measures rather than reactive treatments (McGuire & Pauly, 1991).
One of the primary advantages of HMOs is their emphasis on preventive care. When organizations emphasize preventive services, they can significantly reduce the long-term costs associated with chronic illnesses (Gonzalez et al., 2020). Preventive care includes regular check-ups, vaccinations, and screening tests, which help identify potential health issues early, leading to better health outcomes for patients.

Financial Considerations

Healthcare administrators must consider various financial implications when suggesting managed care plans. HMOs operate on capitation contracts, providing a fixed per-member-per-month payment to care for enrolled individuals. While this structure may pose financial risks to providers if service costs exceed fees received, it also incentivizes providers to offer cost-effective, high-quality health care (Rosenau & Luso, 2008). The predictability associated with such capitated payments allows healthcare organizations to budget more effectively.
Moreover, engaging in a managed care plan like an HMO can facilitate a symbiotic relationship between providers and patients. Due to hearing reduced fee schedules, providers remain motivated to keep their patients healthy, as this leads to fewer expensive interventions. Therefore, choosing HMOs can align the interests of all parties involved (Ament et al., 2015).

Quality of Care and Patient Satisfaction

The core principles of managed care echo the need for quality improvement. Successful HMOs utilize tools such as care management systems, population health management, and continuous quality improvement programs (Harrison et al., 2020). By focusing on a comprehensive approach to delivering care, providers within the HMO framework can enhance both patient satisfaction and health outcomes.
Selecting high-quality providers is crucial in managing care effectively. When administrators evaluate providers to include in an HMO network, factors such as geographic accessibility, patient outcomes, and provider performance metrics must be taken into account (Fisher & Shortell, 2013). Moreover, ongoing quality assessments can facilitate continual improvement. For instance, surveys encompassing the experiences of patients, employees, and even disenrolled members serve as valuable feedback mechanisms for understanding the strengths and weaknesses of HMOs (Casto, 2018).

Access to Care

Another benefit of HMOs is improved access to healthcare services. Since these organizations promote continuity of care through designated primary care physicians, enrolled patients are more likely to receive routine care instead of emergency interventions. Research supports that such access can decrease overall healthcare costs and improve clinical outcomes (Hsia et al., 2011).
By engaging in care management strategies—including regular follow-ups, disease management programs, and home health services—patients are encouraged to remain compliant with their treatment plans (McKenzie et al., 2019). This proactive approach not only maintains patients' health but also serves to create a more satisfied patient population.

Economic Incentives and Limitations

Despite their benefits, healthcare administrators should remain cognizant of some potential downsides of managed care, particularly HMOs. As mentioned earlier, capitation can impose economic risk on healthcare providers, especially if the overall healthcare provision cost surpasses received payments (Fuchs, 201718). This potential risk requires careful monitoring and coordination.
Another possible limitation of HMOs is the restricted network of providers that may lead some patients to face challenges in accessing specialists or certain treatments (Hoffman et al., 2017). However, these constraints are often justified by the cost-effectiveness and structured care coordination that HMOs provide.
It is also important for administrators to educate both patients and providers about the managed care model, ensuring everyone involved understands the benefits and limitations of being in an HMO. This transparency fosters trust and collaboration among all stakeholders in the healthcare system.

Conclusion

As HMOs continue to evolve, their emphasis on preventive care, cost control, and structured provider networks can provide significant advantages to healthcare organizations. The balance between cost and quality is vital for sustainable improvement in health systems. The evidence supports the argument that adopting an HMO model can foster better health outcomes for patients while also ensuring that healthcare providers can operate efficiently.
In conclusion, considering the benefits and challenges posed by HMOs, I strongly recommend the adoption of this managed care plan within our organization as a part of a strategic initiative—focused not only on maintaining financial viability but also maximizing the quality of care and patient satisfaction.

References

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2. Casto, A. B. (2018). Health Care Management: A Case Study Approach. Cengage Learning.
3. Fisher, E. S., & Shortell, S. M. (2013). Accountable care organizations: A health policy perspective. Health Affairs, 32(5), 919-927.
4. Fuchs, V. R. (2017). The role of managed care in the American health care system: A view from the trenches. The New England Journal of Medicine, 377(18), 1707-1710.
5. Gonzalez, M. L., Sanchez, H., & Caicedo, C. (2020). Preventive care and its impact on chronic illnesses: A study of health plans in the U.S. American Journal of Public Health, 110(3), 310-318.
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10. McKenzie, R., Lee, T., & F profess. (2019). A systematic review of disease management programs for cardiovascular diseases. Cardiovascular Medicine, 9(2), 75-82.