Recommended: Theoritical litrecture review of hospital management
In this case, members pay a monthly premium for their compensation to Health Maintenance Organization. Health Maintenance Organization is associated with rules where a member is required to see the doctor in a specific geographical region within a specific network. A member should pay for the medical cover for them to receive the medical services provided by Health Maintenance Organization. In America indemnity and traditional coverage is known as health insurance. An insurance company gives comprehensive coverage to the insured in exchange of a monthly premium.
Memorial Hermann http://www.memorialhermann.org/about-us/ The Memorial Herman health care organization has over 30,000 staff members, including physicians, nurses, clinical and administrative staff, and more. Memorial Herman focuses on evidence-based medicine to provide the best quality and safest care to their patients. Memorial Herman is national known and recognized for this its quality of care.
The best way to view a Medicare HMO directory is through the search portal on the Medicare website. Features include a general search by zip code or a personalized search using a date or birth, zip code and Medicare number. Detailed search results provide Medicare users with HMO organizations, their ratings, information about premiums, deductibles and drug coverage. Compare different HMO plans by choosing providers; charts display drug costs, program coverage, whether there is a choice of doctors and the maximum of-of-pocket expenses.
Family: Jehmari resides with Doxie Samuels (mother) and Junior Copeland (father) in a 2 family house in Plainfield. Jehmari has a close relationship with his mother. He also have a close relationship with his older sister who does not resides in the family home. CM asks Mrs. Samuels how Jehmari is behaving in the home. Mrs. Samuels reports that this time Jehmari is behavior has improved.
The health plans are offered for active duty personnel, their spouses and family, Veterans, Retired Veterans and Veterans with a medical discharge with those Veterans who could receive treatment and with no less than an Other Than Honorable Discharge and with any Veterans Affairs hospital, Veterans Affairs clinic, and military hospitals throughout the world. TRICARE was previously named as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), which previously was a health care program of the United States Department of Defense Military Health System. TRICARE proposes numerous unalike medical plans. All plans meet or surpass the necessities for the least amount. Contributors’ name: (www.tricare.mil).
Managed Care plans are also known as prepaid health care plans. Managed healthcare plans strive to deliver high-quality healthcare, while controlling cost. Services and fees are negotiated with healthcare providers and facilities to provide access to otherwise expensive healthcare services to patients. Services under listed within the Managed Care plan monitored continuously to ensure that all services are provided in the most cost effective manner. An HMO or Health Maintenance Organization is an example of a Managed Care Plan.
Accountable care organization do not uses the transformational model. Instead, ACO’s are involved with the health outcomes of a certain population (Science Direct, 2014). ACOS treat many Medicare and Medicaid COMPARISON OF THE TRANSFORMATIONAL MODEL 4 recipients. They provide care and are given incentives and bonuses for the number patients they treat. ACO’ us the “fee for services” having the goal of providing care for patients yet avoiding unnecessary services (Science Direct, 2014).
In order to make sure the VA is providing the best care to veterans and their families the Department of Veterans Affairs (VA) has a performance and accountability report (PAR). PAR provides results on VA’s progress towards providing America’s Veterans with the best in benefits and health care. The goal of this report is to show how well the VA has done in providing care as well as forward-thinking strategies that are used in order to achieve and maintain excellence. Another plan that is in place to provide the best care is the VA FY 2014-2020 Strategic Plan. This plan uses past successful programs to promote further improvements in quality, customer service, preparedness, and management systems.
ACOs is consider to be groups of doctors, hospitals and insurance companies that connection together to offer a higher-quality of patient care. By improving the quality of care and making more cost-efficient health care decisions. There are ACO core standards in place to ensure that health providers receive the appropriate incentives across the board. ACO’s also have to establish a system wide approach to continuous improvement, and communication, and education to ensure that the quality of care is cost effective. ACO 's Strategic Plan ACO’s require to meet certain benchmarks for keeping patients healthy without requiring a hospital stay.
The Managed Care Organizations it continues the expansion of the products. The MCO business models it changes the services in mixing and volume of the patients and the representation on the multi-year contracts. It provides profiling to the current
Long Term Care Services must be individualized, integrate and coordinated for us to have a better Long term care. Long term promotes the maximum possible independent for people with functional limitations over an extended period of time. The goal is to maintain function and give quality of life on people. It needs to be individualized to provide different services for the individual like physical, mental and emotional and needs to be well coordinated for providers to be responsible for managing the total health care for the individual to be able to exceed the expectations. Managed care is expected to play a big role in the affordable act integrations financing insurance, delivery and payment within one organizational setting.
MCO- Managed Care Organization An organization formed among Primary care Physicians, and specialists to work under Health Maintenance Organization and Preferred Provider organization with aim of improving quality of care and improve health benefits. Concierge Medicine Also known as Retainer Medicine maintains the relation between the patient and their primary care physician by which patient is forced to pay maintenance fee to Primary care Physicians to receive services. Main advantage is it limits number of patients so that PCPs can spend quality time with patient. E&M CODES- Evaluation and management coding Evaluation and management coding are 5 digit current procedural terminology codes that will help in billing the patient-physician encounters.
According to Dye et al. (2013), managed health care is very important since it attempts to address and integrate various functions of delivery. Second, managed care puts into consideration all the mechanisms towards the better utilization of medical services and determines the appropriate price for medical services. Military medical care is another area of the current US health care system to include in the socialized health care system. The reason as to why this needs to be included is to continue catering for medical services for all the military personnel.
Preferred provider organizations (PPO) is type of mange care that provides more choices when seek health care. Unlike an HMO a PPO plan allows its users to out side of the “network” when seeking a health care provider. There is more variety of physicians and hospitals. The cost of a PPO plan varies can vary from user to user depending on the choice year deductible a PPO can have lower or high premium cost. Advantages to PPO plan are the flexibility to choose a provider; a disadvantage is that there poor management of the cost of this plan.
An HMO is a type of managed health care system. Healthcare.gov (n.d.) explains that as long as you stay
