Order Instructions
Textbook:
Title: Strategic management of health care organizations
Author: Linda E. Swayne, Jack Duncan, Peter M. Ginter
Ed/Year: 7th Edition 2013
Publisher: John Wiley & Sons
A new type of third-party-reimbursement health care payment plan is emerging in the United States. Consumer Driven Health Plans strive to control costs and improve quality of care by requiring consumers to take control of their own health care decisions. Consumers decide how they want to spend their health care dollars, depending on what is important to them. CDHPs are geared to encourage participants to enroll in some type of wellness program and improve their lifestyles. Specific types of Consumer Driven Health Plans are:
Health reimbursement arrangements
Flexible spending accounts
Health savings accounts
In this week, you will understand about the three types of Consumer Driven Health Plans. Going further you will consider the problem of health care costs at the national level. Research will be a major part of your work this week as you study CDHPs and attempt to predict their impact on health care in the United States.
Your Learning Objectives for the Week:
Utilize knowledge of the US health care delivery system and public health in analysis, critical thinking and application of information in strategic planning.
Apply business principles of human resources management, operations management, and quality to strategic planning in health care organizations.
Risk-Based Reimbursement
For your assignment, a primary care physician is often reimbursed by Health Maintenance Organizations (HMOs) via capitation, fee-for-service, relative value scale, or salary. Capitation is considered as a risk based compensation.
In an effort to understand the intricacies involved with physician reimbursement, particularly in an era of health care reform, identify and interview an expert in the field, such as:
Hospital Administrator
Managed Care Organization (MCO) executive
Health care Consultant
Legal Professional
Assumption: MCOs use risk-based reimbursement for primary care physicians.
Ask the following questions in the interview:
What kind of risk do the MCOs assess?
Does risk-based compensation limit the freedom of primary care physicians in any way in terms of patient care? Why or why not?
How does the capitation model of reimbursement work? Do physicians generally prefer one model over the other? Why or why not?
Why do HMOs prefer the prepaid, monthly premium?
Is pay-for-performance a better model than existing models of compensation? Are there limitations to it as well?