ipl-logo

Case Study: Green Guard Care

1510 Words7 Pages

Green Guard Care is an insurance company that is facing financial problems especially with their margins and profits. They currently have a contract with Arc Electric that pays each employee a fixed amount of $250. The contract can be reviewed and the increasing in physician the reason for decreasing the profits ability of the company. However, Luis Pasture has asked help from his employees to find the solution to their revenue that the company has been receiving. The solutions show the increasing of the copayment of each employee or the decreasement of physician cost. Using the statistical, economical as well as ethical analysis, the report would determine the rise of physician use is dependent on the current copayment price. The allocation …show more content…

Pasture raised the concerns on the increasing cost of doctors from July to August especially regarding to their healthcare contract with Arc Electric, Inc. The company fears that many aspects of their contracts would reduce their profits. The data provided could not explain the reasons for the increasing visits of the Physician in the same duration. Instead, there is a jump of data that shows the increase in from July to August in other categories. Furthermore, the number of employees covered with insurance increased by 8 people. Hence, there must be another reasons for the current employees who are visiting doctors more often. The recommendation would examine the issue and interviews specific employees who have been visiting the physician more often than …show more content…

This create a leeway to determine if the doctor visits are dependent when the number of employees increases. The scatter plot models (see appendix 1.3) help determine the relationship between two variables. The analysis of the variables in this case are expenses (cost) and employee visits to the physicians. The scatter plots show the line drawn to best fit and the lines to determine if the listed variables are dependent of each other. The correlation between the data points show a slightly positive trend. This trend suggests that the numbers of visits increase as additional employees join the healthcare membership, therefore increasing costs. Finally, it is important to point out that the correlations do not equal the causation and therefore, it is merely a suggestion of the outcome. Visits per employee and the cost per visits (see appendix 1.4) were calculated to create variables showing the comparison between them over

Show More
Related
1251 Words | 6 Pages

The author really did not mention any positive examples of American medical insurance system’s work. It creates a feeling of prejudice as the system should have positive results to exist for so many years. However, Moore gave enough examples to show there are severe problems in the American medical insurance. Mentions of numbers, historical recordings and people, who decided to share personal experience, support author’s

Read More
436 Words | 2 Pages

In the aforementioned argument, the Leeville Chamber of Commerce stated that Leeville town workers taking fewer sick days and having a lower possibility of being diagnosed with stress-related illness than Masonton workers can be attributed to the health benefits of the relatively relaxed peace of life in Leeville. The explanation about these facts may seem convincing; however, there are more plausible alternative explanations to account for them. First, it is plausible that the number of sick days reported by workers in Leeville are simply fewer than those by workers in Masonton. To be specific, if Leeville only has small scaled clinics operated by individuals, workers would not go to the hospital in Leeville and instead endure their sickness without seeking medical attention. Also, it is possible that workers in a small town such as Leeville would head for the large city of Masonton to receive medical treatment since there are no large hospitals and specialized hospitals in Leeville since the town is too small for such hospitals to be profitable.

Read More
687 Words | 3 Pages

improving quality of American health care system and curbing the care costs, at the moment numerous ways of restructuring care supply are being evaluated by CMS. Accompanying Medicare shared savings program, initiatives like Advanced Payment Incentive and Pioneer ACO demonstrations are being commenced. Other global health service organizations such as Cigna, Aetna and Anthem are also supporting this health reform model and endeavoring to improve health service system by acquiring health service providers to raise the level and quality of care supply. As well as this kind of health insurance companies provide other incentives to healthily systematized care provider

Read More
507 Words | 3 Pages

The major requirement to start health reimbursement account is that the plan must be funded solely by the employer, and not by reduction of salary. In addition, the plan may only provide benefits for verified medical expenses. With Health Reimbursement arrangements, employee healthcare expenditures are visible and obvious to both employee and employer, thereby promoting a better understanding of the costs of health care. In addition, employees who can monitor and control their health care costs become smarter health care consumers. How Do Employers Benefit From A

Read More
475 Words | 2 Pages

Discuss the ethical implications of “medical necessity” in patient care. Ethical Implications of Medical Necessity When it comes to medical necessity can often refers to the determination that is made for the insurance purposes. For example, If the patient has a condition that is chronic or terminal, the treatment could be considered medically necessary whether then the patient can afford the treatment or not. Networked doctors may face ethical dilemmas when recommending treatment or specialist referrals. When it comes to medical necessities it can be controversial, it can be the use of marijuana when there can be others that are more a moral ethical in which it can be in manage care and network providers.

Read More
217 Words | 1 Pages

In the healthcare organization, revenue is mostly earned by providing services to patients. These services normally have established rates, and depending on those rates the organization calculates the estimate revenue. However, these payments are normally settled by the patient’s insurance companies like the government, commercial insurers, private pay, and others which differs patients to patients. All these different payers have their different contracts and sub contracts with the healthcare organizations, and depending on them, their rates maybe differ. Therefore, it makes big difference in the total revenue unlike any non-healthcare or for-profit business that does not have to deal with many different payers for the same provided service.

Read More
104 Words | 1 Pages

Some advantages that might be able to help our particular issue is to offer more incentives to providers and health care workers to help improve the continuity of care. We can put into practice fee-for service for the healthcare providers so that they don’t have to worry about the possibility of not getting paid. Fee- for service model of healthcare reimbursement on its head, causing providers to change the way they bill for care. Instead of being paid by the number of visits and tests they order (fee-for-service), providers’ payments are now based on the value of care they deliver (value-based care) (Health

Read More
1122 Words | 5 Pages

Understanding the importance of provider reimbursement and the different methods of healthcare financing can be beneficial. This can aid in understanding which financing method provides the most benefits to providers. Healthcare providers along with healthcare organizations require funds to assist in the continuation and the revolving of healthcare services. References Casto, A. B., & Layman, E. (2006). Principles of healthcare reimbursement.

Read More
661 Words | 3 Pages

Today's health care system has become lots additional various than within the past. Not solely square measure there a good form of doctors specializing in everything from head to toe and specific conditions and unwellness, however additionally there square measure hospitals, clinics, and medical offices on the market to treat your each complaint. thus with of these choices, however does one recognize wherever to travel and what form of medical man and treatment to choose? With the increase of medication and surgery within the twentieth century additionally came the danger of overuse, complications and facet effects. typical medication, that was the mot wide, trusty health care system within the North American country turned against its patients and become a political game involving drug firms, persuader and hospital kickbacks.

Read More
1963 Words | 8 Pages

This shifts the populace towards using the emergency room more and of course opening even more holes in the hospitals budget. What can and cannot be covered by reimbursement plans is another problem that should not only be addressed, but also something that is not just endemic to the Federal government’s payments. Because the patient does not usually see the whole bill to a visit and there are not many laws in place to protect against this, prices of care are often inflated beyond what they should (though part of this is to cover for the aforementioned holes caused by the emergency rooms). This in turn means price controls are virtually nonexistent. For those with good insurance it is not usually a big deal.

Read More
749 Words | 3 Pages

We are presently going through some changes within the company and will be requiring a significant increase in employee financial contribution to help offset health insurance costs. This change is necessary to help the company continue to grow its revenue and with the increasing costs of health insurance it is essential for the employees to take on some of the burden.

Read More
683 Words | 3 Pages

Cosgrove said the Cleveland Clinic managed to reduce the cost of running its pharmaceutical supplies by $10 million, but those savings were offset by $11 million in cost increases by Valeant Pharmaceuticals, which has attracted government scrutiny for its pricing practices. Although many clinics and health care offices are adhering to consolidating to these new practices the quality of the care still remains. Many drug companies are producing affordable drugs that the clients can afford. Also many health care providers are streamlining pay option to people who don’t have insurance to get the health care they are needing whom otherwise may go without simply because treatment isn’t

Read More
535 Words | 3 Pages

Prospective reimbursement certain pre-established criteria are used to determine the amount to be reimbursement. Through the reimbursement methods they provides pre-established amounts and also bundle rate that include everything. In doing so it keeps the cost a lot less by rewarding providers to keep the cost down. 18. Based on the information in your text, how were the National Health Expenditures were spent and what impact did this have on the Gross Domestic Product (GDP) and the Consumer Price Index

Read More
898 Words | 4 Pages

Hospital compare helps citizens find information for hospitals all over the country. This information helps the patients and their families make the best choice for their monetary restrictions and their health choices. This helps them find out whether the quality of care is adequate for their needs between many hospitals in the patient's home area. Hospital compare helps the patient by making the decision process easier, and making hospitals improve their health care quality. Patients can find a variety of information about the hospitals quality; including general ratings of the hospital, general information, payment and value of care, timely and effective care, and much more information on this website.

Read More
295 Words | 2 Pages

Today in the United States cost- sharing plays a vast part in the health care industry. The three forms of cost sharing are deductibles, co-payments, and coinsurance. Cost sharing saves the insurance companies money. However, it creates a powerful incentive for the consumer to search for alternate insurance that does not have out-of-pocket expenses. Medical services with complex benefits is common for the consumer to have little or limited knowledge of how their insurance plan works.

Read More

More about Case Study: Green Guard Care

Open Document