Hgmt 420 Assignment 5student Nametype Your Name Hereassignment 5 Ti ✓ Solved

HGMT 420 Assignment #5 Student Name: Type your name here Assignment #5 Title HealthChoice/Maryland Managed Care Plan Benefits Offered and Services Covered You want a plan that offers a comprehensive benefits package including preventive care as well as treatment programs for chronic disease management. Also, you may need emergency care and/or care away from home. What questions would you ask to determine the benefits and covered services offered? Evaluate the HealthChoice plan and summarize your findings. Cost vs.

Benefits Managed care plans vary widely in the cost of services offered. It may be tempting to base your selection primarily on the periodic, out-of-pocket costs to you. You can’t be sure that the least expensive plan will give you all the medical services you need. Review cost vs. benefits for the HealthChoice plan carefully and summarize your findings. Services of the Primary Care Physician Choosing your primary care physician (PCP) may be the most important decision you make when enrolling in a managed care plan.

The following questions are important when choosing your plan: Please answer each question. · Can you choose more than one PCP for your family? · Is there a large choice of primary care doctors and specialists? · How long is the average wait to get an appointment with the chosen PCP? · Can you see the same doctor consistently? · When and how can you change doctors if you are dissatisfied How does HealthChoice measure up? Prescription Drug Benefits When evaluating a health plan it is very important to know what kind of prescription drug benefits the plan offers. Depending upon the plan, there are several systems that have been implemented in efforts to control costs. Some plans offer a “generic only†plan.

What prescription drug benefits does HealthChoice offer? Are they beneficial to your current drug regimen? Provider Network and Geographic Service Area Be sure you inquire from the Provider Membership Directory which providers are included in the network and where they are located in your community. If you live in one community and work in another; determine if routine care can be received in either location. Does HealthChoice have a strong network of Providers in a geographic area that is amenable to you?

Must you go to different locations for different services? If you have a child away at school, does the network extend to that area? Commitment to Quality of Care and Service What measures of quality care and satisfaction of service are available? It is worthwhile to find out if the plan has been accredited by the National Committee for Quality Assurance (NCQA). NCQA is the most common accrediting body for network plans.

Review and report on what measures of quality care and satisfaction are available for HealthChoice. Customer Satisfaction How do enrolled members feel about the plan? There are various objective forms of measurement used to determine “quality services†given by managed care plans such as accreditation, HMO report cards and/or publications produced by the industry. You would be wise to look at any that measure customer satisfaction. The National Committee for Quality Assurance (NCQA) mission is to provide information that enables purchasers and consumers of managed health care to compare plans based on quality.

Their web site may be reached at Limitations, Maximums, or Exclusions Lifetime Cap refers to the maximum dollar amount of benefits available to a consumer in a managed care plan during his or her lifetime. This amount becomes important when confronted with a life-threatening disease or accident that requires prolonged care involving expensive therapeutic intervention and support. Does HealthChoice outline limitations, maximums, or exclusions? Case Report Writing Guidelines – Dr. Dean Saluti No Cover Page: at the top of the page, left-hand corner, Name/Names; right-hand corner, Course Number and below it, Date; skip a couple of lines, Name of the Case, bold, underlined, centered Background: skip a couple of lines from the Case Title, move to the left margin, and the heading for the first section will be Background:, bold, underlined, colon.

This section will have short paragraphs, not indented, single spaced, starting below the section heading. With a long, detailed HBP case, this section could be a page in length. A description of the company, its products/services, and its history should be included in the beginning of this section. Some outside research may be required, so don’t forget APA references. This section leads up to the Issue (problem) that must be addressed in the case.

Issue: skip a couple of lines from the end of the Background section, move to the left margin, and the heading for the next section will be Issue:, bold, underlined, colon. This is always only one sentence, under the heading, ending with a question mark. Alternatives: skip a couple of lines from the end of the Issue sentence, move to the left margin, and the heading for the next section will be Alternatives:, bold, underlined, colon. Under the heading, number and list reasonable, possible Alternatives that will resolve the Issue. Alternatives should be expressed succinctly and can be just a few words or sentence fragments.

It is important not to include Alternatives that are not feasible. Analysis of Alternatives: skip a couple of lines from the end of the Alternatives section, move to the left margin, and the heading for the next section will be Analysis of Alternatives:, bold, underlined, colon. Under the heading, cut and paste the first Alternative (number and text), preceded by the Word “Alternative,†bold, underlined, followed by the word “- Suboptimal†or “- Optimal,†also bold, underlined. Don’t forget the dash (-). Under the Alternative, in a few short sentences, single spaced and not indented, describe why the specific Alternative is “- Suboptimal†(not to be Recommended) or “- Optimal,†(to be Recommended).

Repeat for each Alternative to be analyzed and skip a line between Alternatives. Recommendation: skip a couple of lines from the end of the Analysis of Alternatives section, move to the left margin, and the heading for the next section will be Recommendation:; bold, underlined, colon. Under the heading, begin with “This Report recommends:†and then list, with bullet points, the Optimal/Recommended Alternative(s) in a few words or sentence fragments. Attachments: any Attachments should follow the body of the Report on separate pages. Each Attachment (map, diagram, picture, etc.) should have a reference on the bottom of the Attachment as to where it was taken from, should be labelled (e.g., Attachment 1), titled (e.g., Map of Corporate Office Locations Worldwide), and should be referred to in the body of the Report (usually in either the Background or Analysis section).

References: This is the last page of the Report. Use APA guidelines.

Paper for above instructions

Student Name: [Your Name Here]
Course Number: HGMT 420
Date: [Insert Date Here]
HealthChoice/Maryland Managed Care Plan Benefits Offered and Services Covered
Background:
HealthChoice is Maryland's Medicaid managed care program, designed to provide healthcare coverage to low-income families, children, pregnant women, and individuals with disabilities. Launched in 1997, HealthChoice aims to improve access to care while controlling costs (Maryland Department of Health, 2023). Participants are enrolled in managed care organizations (MCOs) that handle their healthcare services. The comprehensive benefits package includes routine check-ups, preventive services, chronic disease management programs, emergency care, and treatment for mental health and substance use disorders. Understanding what HealthChoice offers, particularly its preventive care programs, treatment for chronic diseases, and access to emergency services, is essential for those needing reliable healthcare coverage.
Issue:
What benefits and services does the HealthChoice plan offer to ensure comprehensive healthcare coverage for enrollees?
Alternatives:
1. Investigate the comprehensive nature of preventive and routine care benefits.
2. Examine the chronic disease management programs available.
3. Analyze the accessibility and quality of emergency care and out-of-home services.
4. Assess options regarding primary care physician (PCP) selection.
5. Explore prescription drug benefits and formulary options.
Analysis of Alternatives:
Alternative 1: Investigate the comprehensive nature of preventive and routine care benefits - Optimal
HealthChoice covers a wide array of preventive services, including annual check-ups, immunizations, and screenings. Preventive care plays a vital role in identifying health issues early and promoting general well-being (Centers for Disease Control and Prevention [CDC], 2023). This comprehensive coverage is a significant advantage for enrollees, as it allows access to necessary health assessments without co-pays or deductibles.
Alternative 2: Examine the chronic disease management programs available - Optimal
HealthChoice offers integrated chronic disease management programs that help individuals manage conditions like diabetes, hypertension, and asthma (Maryland Department of Health, 2023). These programs often include personalized care plans, access to specialists, and tools for tracking health metrics. Effective management of chronic diseases is crucial for improving quality of life and reducing long-term healthcare costs, making this an essential aspect of the plan.
Alternative 3: Analyze the accessibility and quality of emergency care and out-of-home services - Optimal
HealthChoice recognizes that emergencies can occur at any time, so it provides access to emergency care regardless of service area. This feature is critical for enrollees who may travel or have children attending school in different areas (Maryland Department of Health, 2023). The availability of urgent care facilities within the network further enhances accessibility, ensuring timely treatment when needed.
Alternative 4: Assess options regarding primary care physician (PCP) selection - Optimal
Choosing a PCP is a pivotal decision in the HealthChoice plan. Enrollees typically can select from a network of PCPs, offering flexibility in choosing a provider who meets their needs (Maryland Department of Health, 2023). Additionally, some MCOs within HealthChoice allow families to select different physicians for family members, which can enhance individual preferences and comfort.
Alternative 5: Explore prescription drug benefits and formulary options - Optimal
HealthChoice has a formulary that includes various medications, often categorizing them into tiers that affect copay amounts (Centers for Medicare & Medicaid Services [CMS], 2023). Enrollees can obtain generics, preferred brand-name drugs, and non-preferred drugs, ensuring they can access medications relevant to their health conditions. Evaluating the formulary is crucial for understanding the affordability and availability of necessary prescriptions.
Recommendation:
This report recommends:
- Leverage comprehensive preventive and routine care benefits to ensure health assessments are up to date.
- Utilize chronic disease management programs to improve health outcomes for long-term conditions.
- Rely on the network's emergency care options for accessible and timely help regardless of location.
- Encourage families to consider individual physician preferences when selecting a primary care provider.
- Review and utilize the prescription drug formulary to manage medications effectively.
Commitment to Quality of Care and Service:
HealthChoice is committed to quality service, as evidenced by its accreditation from the National Committee for Quality Assurance (NCQA) (NCQA, 2023). The NCQA evaluates plans based on performance measures, quality improvement, and patient satisfaction metrics. HealthChoice conducts member surveys to assess satisfaction, providing further insight into enrollees' experiences. Metrics on avoidable hospitalization rates and chronic condition management effectiveness are also tracked, ensuring ongoing improvements in service quality.
Customer Satisfaction:
Member feedback is crucial in evaluating the HealthChoice plan. Surveys and independent studies reveal that enrollees report high satisfaction levels with their overall care experiences, citing ease of access to providers and timely care (Maryland Health Care Commission, 2023). Moreover, HealthChoice's commitment to transparency and quality improvement initiatives further builds trust among its members.
Limitations, Maximums, or Exclusions:
HealthChoice outlines various limitations and exclusions within its documentation. Notably, there may be restrictions on certain types of elective procedures or specialized care not pre-approved by the MCO (Maryland Department of Health, 2023). Enrollees should also be mindful of their annual benefit limits and conditions that may lead to maximum expenditure thresholds, especially significant concerning chronic illness management.
Conclusion:
The HealthChoice plan provides a comprehensive benefits package that includes preventive care, chronic disease management, emergency services, and a diverse network of physicians. Understanding the balance of costs versus benefits is essential for making informed decisions regarding healthcare coverage. Access to quality care, flexibility in provider selection, and positive member feedback indicate that HealthChoice is a reliable option for Maryland residents seeking managed care.
References:
- Centers for Disease Control and Prevention (2023). Preventive Services for Adults. Retrieved from https://www.cdc.gov/prevention/
- Centers for Medicare & Medicaid Services (2023). Pharmacy Benefits. Retrieved from https://www.cms.gov/
- Maryland Department of Health (2023). About Maryland's HealthChoice Program. Retrieved from https://health.maryland.gov/healthchoice
- Maryland Health Care Commission (2023). Member Satisfaction Report. Retrieved from https://mhcc.maryland.gov/
- National Committee for Quality Assurance (2023). NCQA Health Plan Ratings. Retrieved from https://www.ncqa.org/
- Medicare Rights Center (2023). Choosing a Health Insurance Plan. Retrieved from https://www.medicarerights.org/
- Kaiser Family Foundation (2023). Medicaid Managed Care. Retrieved from https://www.kff.org/medicaid/
- American Health Care Association (2023). Managed Care Quality Analysis. Retrieved from https://www.ahcancal.org/
- The Commonwealth Fund (2023). Health Care Quality: Current Trends and Future Directions. Retrieved from https://www.commonwealthfund.org/
- Healthcare Cost and Utilization Project (2023). Quality of Care in Managed Care Plans. Retrieved from https://www.hcup-us.ahrq.gov/
This report is designed to provide a sound overview and evaluation of the HealthChoice plan, essential for prospective enrollees in understanding available benefits.