Assignment 3 Health

3-5 pages APA format

Managed care has had a profound impact on the way that health care is delivered and paid for in the United States. A large portion of Healing Hands Hospital’s revenue comes from managed care reimbursement making managed care a very important part of the business process. Part of the Task Force’s work will include obtaining feedback from the community and a public relations committee has been formed to help educate the community when decisions are made about changes to Healing Hands Hospital. Mr. Johnson, Healing Hands Chief Financial Officer, has asked you to help provide some training to the members of the public relations committee to help them understand managed care and other possible models for reimbursement including value-based reimbursement and Accountable Care Organizations (ACOs), so this can be included in their campaign of community education. Your report to Mr. Johnson should include:

  • Identify three types of managed care plans, such as Preferred Provider Organizations (PPO) and how they impact the way that health care is delivered at Healing Hands Hospital.
  • Managed care has changed dramatically in the United States over the years. What did managed care look like 10 years ago compared to how it looks today?
  • Discuss the future of managed care as a viable reimbursement model for Healing Hands Hospital compared to Accountable Care Organization model and valued based reimbursement.
  • Reimbursement by CMS for Medicare patients is also an important source of revenue for Healing Hands Hospital. Include a description of the different models for Accountable Care Organizations (ACOs) and what would be a good strategy for Healing Hands to ensure the highest level of Medicare reimbursement for the future.
  • Through legislation such as the Affordable Care Act and MACRA, there are regulations and requirements that are designed to improve patient quality of care and ensure highest levels of reimbursement. Include how these laws impact Healing Hands Hospital and its financial plans.

Mr. Johnson, like all healthcare management professionals, believes that the data and information presented must be backed by good research and the reference sources must be listed appropriately in the written report.
Be sure to include at least three references for the information presented in your report using APA formatting.
3-5 pages

Expert Solution Preview

Managed care has been a significant factor in shaping the delivery and financing of healthcare services in the United States. As a medical professor, this report aims to provide a comprehensive understanding of managed care plans, including their impact on Healing Hands Hospital. The report will discuss the changes in managed care over the years, the future of managed care as a reimbursement model compared to the Accountable Care Organization (ACO) model and value-based reimbursement. Additionally, the report will explore different ACO models, strategies that Healing Hands can adopt for the highest level of Medicare reimbursement, and the impact of legislative laws such as the Affordable Care Act (ACA) and MACRA on the hospital’s financial plans.

Identifying Three Types of Managed Care Plans:
Managed care plans are healthcare plans that seek to control costs while maintaining quality healthcare services. Three types of managed care plans include Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Point of Service (POS) plans. HMOs provide healthcare services through a selected provider network. Patients need a referral to see a specialist or receive non-emergency care from a provider not in the network. PPOs give patients the freedom to choose in-network or out-of-network providers, but they will pay higher fees for non-network providers. POS plans combine HMO and PPO plans by allowing patients to seek care both in-network or out-of-network.

Impact of Managed Care Plans on Healing Hands Hospital:
Managed care plans have a considerable impact on how healthcare services are delivered at Healing Hands Hospital. The hospital must contract with managed care organizations to participate in their networks or face losing a significant portion of their revenue. The plans also impact the hospital’s operations, requiring them to follow specific provider guidelines and documentation requirements. While HMO plans offer cost savings for both patients and hospitals, the restrictions in the provider network can limit patient access to care. PPO and POS plans are costly to both patients and hospitals, with hospitals negotiating lower reimbursement rates from them to remain competitive in the market.

Changes in Managed Care:
Managed care has changed significantly over the years. Ten years ago, health insurance providers focused on controlling costs by reducing the number of procedures and services that they would pay for, resulting in limited access to care. Today, providers have shifted to value-based reimbursement models, which reward providers for higher quality care rather than the number of procedures and services. Also, hospitals face increased competition in the market as more healthcare providers offer their managed care plans, leading to lower reimbursement rates.

The Future of Managed Care:
Managed care is likely to persist as a reimbursement model, but it will face tough competition from ACO models and value-based reimbursement. ACO models provide incentives for healthcare providers and insurers to work together to deliver value-based care. They focus on preventive care, reducing unnecessary hospitalizations, and improving patient outcomes. Similarly, value-based reimbursement rewards providers for higher quality care, which aligns with the hospital’s mission of providing quality healthcare services.

Different ACO Models:
There are several ACO models, such as the Medicare Shared Savings Program, Pioneer ACO Program, and Next Generation ACO Model. Each model has its features, benefits, and eligibility requirements. For instance, the Medicare Shared Savings Program is open to healthcare providers and hospitals who are Medicare fee-for-service patients, while the Pioneer ACO Program is only available to healthcare providers and hospitals who already participate in the Medicare Shared Savings Program.

Strategies for Maximum Medicare Reimbursement:
To ensure the highest level of Medicare reimbursement, Healing Hands Hospital can adopt various strategies, such as forming partnerships with other healthcare providers to participate in different ACO models, implementing value-based care initiatives, and improving the hospital’s overall performance through quality improvement projects. The hospital can also ensure that it meets all eligibility requirements and provides the required documentation and patient data to maximize its reimbursement.

Impact of Legal and Regulatory Requirements:
The ACA and MACRA have impacted Healing Hands Hospital and its financial plans positively. The laws provide incentives for quality initiatives, such as electronic health records (EHR) implementation and improving clinical outcomes, which lead to higher reimbursement rates. Additionally, the laws encourage preventive care and reduce non-emergency hospital visits, which lead to cost savings for patients and hospitals.

In conclusion, understanding managed care is essential for the public relations committee at Healing Hands Hospital. While managed care has significantly impacted the healthcare industry, it faces tough competition from ACO models and value-based reimbursement plans. To ensure maximum Medicare reimbursement and provide quality healthcare services, Healing Hands Hospital can implement different strategies and initiatives, such as forming partnerships and quality improvement projects. Finally, legislative laws such as ACA and MACRA have had a positive impact on the hospital, encouraging quality initiatives and reducing unnecessary hospital visits.

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