MHA500 Discussion, paper and powerpoint

 

1. There is a discussion (minimum of 1-2 pages) needed by Tuesday NLT 5PM, 22 Sept.20.

2. There is a Case Paper assignment due Fri 25 Sept NLT 5PM.

3. SLP Paper NLT Mon 28 Sept, 5 PM

No Plagiarism of any kind, no paraphrase or word for word….

These papers must be done on time and according to requirements.  You must read the instruction and use the proper formats and references. ” At least” 4 Ref’s cited on all assignments

I need a very professional paper and will have more for the right tutor.

on time

Module 3 – Home

MANAGED CARE, ACCOUNTABLE CARE ORGANIZATIONS, HEALTH CARE CONSUMER PLANS/MODELS

Modular Learning Outcomes

Upon successful completion of this module, the student will be able to satisfy the following outcomes:

· Case

· Evaluate and describe key features of CDHPs, MCOs, HMOs, PPOs, POSs, and ACOs.

· SLP

· Distinguish characteristics for successful business operations/administrations and apply appropriate health care models.

· Discussion

· Assess a health insurance plan and propose recommendations for improvement.

Module Overview

Managed Care Organization (MCOs)

An MCO is a type of health care system that links health insurance with care delivery for a defined population. An MCO delivers health care through a network of providers, determines the prices for services, coordinates care, and manages appropriate use of health care services. One of the goals of the MCO is to provide the highest quality of care within the limits of available resources.

Health Maintenance Organization (HMO) — Closed Panel HMO

· Key features:

· Contract with physicians and physician groups on an exclusive basis.

· Physicians do not see patients from other HMOs.

· Patients need to select a PCP and require a referral for specialty care.

· Highest restriction for access. No payment for outside network providers if services are rendered outside of HMO network.

· Two Types:

· Staff Model:

· Physicians are salaried employees of HMO.

· HMO owns hospitals and other health care facilities.

· Hospitals and facilities open to HMO members only (in principle).

· Group Model:

· Contracts with a single medical group for services.

· Physicians employed by the medical group, not the HMO.

· The medical group practices with the HMO only.

Health Maintenance Organization (HMO) — Open Panel HMO

· Key features:

· Contracts with independent physicians.

· Physicians see patients in the physician’s own office.

· Physicians can see patients from other HMO’s.

· Patients need to select a PCP and require a referral for specialty care.

· Two types:

· Network Model:

· Contracts with multiple medical groups or independent delivery network (IDN).

· IPA Model

· Contracts with an independent physician or physician associations.

· Providers paid on a discounted fee schedule or capitation.

· High volume of patients.

Preferred Provider Organization (PPO)

· Key features:

· Contracts with independent physicians and hospitals as “preferred” network.

· Physicians see patients in the physician’s own office and are paid with a negotiated fee.

· Patients do not need a PCP and no referral is needed for specialty care.

· The least restrictive MCO plan.

Point of Service (POS)

· Key features:

· Between HMO and PPO.

· Members need a PCP and referral for specialty care with HMO benefits.

· Members can go outside of network for services (with a higher deductible and co-payments).

ACOs

According to the National Accountable Care Organization Summit (n.d.), ACOs are provider collaborations that support the integration of groups of physicians, hospitals, and other providers in different ways around the opportunity to receive additional payments by achieving continually advancing patient-focused quality targets and demonstrating real reductions in overall spending growth for their defined patient population. The ACO model is highly flexible and can be organized in several ways—ranging from fully integrated delivery systems to networked models within which physicians in small office practices can work effectively together to improve quality, coordinate care, and reduce costs. According to Shortell, Casalino, and Fisher (2010), there are at least five different types of practice arrangements that could serve as ACOs:

1. integrated or organized delivery system

2. multispecialty group practices

3. physician-hospital organizations

4. independent practice associations

5. “virtual” physician organizations,

Burton, D. (2014). What Is an ACO? Definitive Guide: Accountable Care Organizations. Retrieved from 

www.healthcatalyst.com/what-is-an-ACO-definitive-guide-accountable-care-organizations.

National Accountable Care Organization Summit. (n.d.). What is an ACO? Retrieved from 

http://www.acosummit.com/past2011/overview.html

Shortell, S. M., Casalino, L. P. & Fisher. E. S. (2010). How the Center for Medicare and Medicaid Innovation should test Accountable Care Organizations. Health Affairs, 29 (7), 1293-1298.

Discussion Assignment: MCO’s vs. ACO’s

 

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For this discussion, research your own health insurance plan or a plan that you are familiar with. You may also choose a plan from the Federal OPM at 

https://www.opm.gov/healthcare-insurance/healthcare/plan-information/compare-plans/

Complete the following:

· Identify the type of insurance plan (e.g. HMO, PPO, etc.)

· Describe your experience with this insurance plan.

· Identify 2-3 problems with the plan.

· Identify 2-3 recommendations for improvements to the plan.

Support your thoughts with scholarly resources.

Module 3 – Background

MANAGED CARE, ACCOUNTABLE CARE ORGANIZATIONS, HEALTH CARE CONSUMER PLANS/MODELS

*****Required Reading*****

Feeley, T. W. & Motha, S. N. (2018). New marketplace survey: Transiting payment models: Fee-for-service to value-based care. Retrieved from 

https://catalyst.nejm.org/transitioning-fee-for-service-value-based-care/

Haas, S. (n.d.). Health Reform Act: New models of care and delivery systems. Retrieved from 

https://www.aaacn.org/health-reform-act-new-models-care-and-delivery-systems

Plunkett, L. (2015). Accountable care organizations. New York State Dental Journal, 81(3), 4–7.

Shi, L., & Singh, D. A. (2017). Chapter 9 Managed care and integrated systems. In Essentials of the U.S. health care system (4th ed.). Burlington, MA: Jones & Bartlett Learning. Retrieved from the Trident Online Library.

World Health Organization. (n.d.). Health care delivery models. Retrieved from 

https://www.who.int/hac/techguidance/tools/disrupted_sectors/module_07/en/index3.html

Wood, D. (2013). Providers getting creative with new healthcare delivery models. Retrieved from 

https://www.amnhealthcare.com/latest-healthcare-news/provider-getting-creative-new-healthcare-delivery-models/

Required Videos

Aetna. (2017). What’s the difference between an HMO, a POS, and a PPO? | Health care answers in 60 seconds. [Video file]. Retrieved from 

Kaiser Health News. (2015). The ABC’s of ACO’s. Retrieved from 

FAIR Health. (2017, November 1). Point of service (POS) (Part 4 of 8)—FAIRHealthConsumer.org [Video file]. Retrieved from 

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Module 3 – Case Assignment

MANAGED CARE, ACCOUNTABLE CARE ORGANIZATIONS, HEALTH CARE CONSUMER PLANS/MODELS

Assignment Overview

There are various types of plans consumers can select. MCOs, HMOs, PPOs, POSs, or ACOs are the most common ones; however they all supply various benefits and drawbacks. Consumers (patients) have the right to choose the type of plan that best fits their needs. As a health care leader, it is vital that you understand the differences in these plans. In addition, in a health care environment where there are plenty of options for consumers (e.g., providers, medical offices, location, consumer plans etc.), ideally making the “choice” is left up to the consumer’s determination.

Case Assignment

For the Module 3 Case Assignment, conduct additional research as needed and complete the following:

· Part 1 – Comparative Chart:

· Prepare a detailed comparative chart (see example at the following source: 

https://philsblogspace.files.wordpress.com/2012/10/eco-chart ?w=1400).

 In your comparative chart, evaluate and discuss the key features, differences, and disadvantages between MCOs, HMOs, PPOs, POSs, and ACOs.

· Part 2 – Designed an Application (App):

· In the world of technology, the “consumer choice” is often swayed by their research efforts or applications. In at least 2 pages, design an app to assist consumers with making a choice between the various consumer plans. Be creative and detailed about your application. Explain the contents of the application that you create and why you feel it would be beneficial to consumers.

In your scholarly paper, you should include an introduction and conclusion paragraph.

Assignment Expectations

1. Conduct additional research to gather sufficient information to justify/support your thoughts and analysis.

2. Limit your response to a maximum of 4 pages.

3. Support your report with peer-reviewed articles, with at least 3 references. Use the following link for additional information on how to recognize peer-reviewed journals. Angelo State University Library (n.d.) Library guide: How to recognize peer reviewed (refereed journals). Retrieved from: 

https://www.angelo.edu/services/library/handouts/peerrev.php

4. You may use the following source to assist in formatting your assignment. Purdue Online Writing Lab. (n.d.). General APA guidelines. Retrieved from: 

https://owl.english.purdue.edu/owl/resource/560/01/.

5. For additional information on reliability of sources review the following source. Georgetown University Library (n.d.) Evaluating internet resources. Retrieved from 

https://www.library.georgetown.edu/tutorials/research-guides/evaluating-internet-content

Module 3 – SLP Assignment

MANAGED CARE, ACCOUNTABLE CARE ORGANIZATIONS, HEALTH CARE CONSUMER PLANS/MODELS

For your Module 3 SLP, read the following article:

Rodak, S. (2012). 10 Pillars of Success for Top Healthcare Workplaces. Retrieved from 

http://www.beckershospitalreview.com/hospital-management-administration/10-pillars-of-success-for-top-healthcare-workplaces.html

You have been named the Administrative Director at Trident International Hospital (TIH) and will be presenting a PowerPoint (PPT) to the Board of Directors for approval. TIH is restructuring to meet the current needs of their consumers. The article discusses 10 pillars of success for top health care workplaces. In your PPT:

1. Present and discuss how these pillars are vital to TIH’s consumers, support services, business operations, and administration.

2. Research and select a health care model (i.e., Value Based, Volume Based, Fee-For-Service, Cost-Based, etc.) for TIH.

a. Provide rationale on how the selected model addresses the 10 pillars of success and will meet the current needs of TIH’s consumers.

Your PPT should be professional and provide substantial information. It should be 15-18 slides (not including the title and reference slide).

Speaker notes are required.

SLP Assignment Expectations

1. Conduct additional research to gather sufficient information to support the design of your PPT.

2. Limit your total PPT to a maximum of 18 slides, not including your title or reference slide.

3. Support your report with peer-reviewed articles, with at least 3 references. Use the following link for additional information on how to recognize peer-reviewed journals. Angelo State University Library (n.d.) Library guide: How to recognize peer reviewed (refereed journals). Retrieved from: 

https://www.angelo.edu/services/library/handouts/peerrev.php

4. You may use the following source to assist in formatting your assignment. Purdue Online Writing Lab. (n.d.). General APA guidelines. Retrieved from: 

https://owl.english.purdue.edu/owl/resource/560/01/.

5. For additional information on reliability of sources review the following source. Georgetown University Library (n.d.) Evaluating internet resources. Retrieved from 

https://www.library.georgetown.edu/tutorials/research-guides/evaluating-internet-content