...a Community Health Centers? Community health centers are public or non-profit clinic sites located in medically underserved, rural, and urban areas throughout the nation. They receive grants under the Community and Migrant Health Centers Program of the US Department of Health and Human Services to provide primary and preventive care to community residents. Community health centers remove common barriers to care by serving communities that otherwise confront financial, geographic, language/cultural and other barriers, making them different from most private, office-based practices. CHCs are: • Located in high-need areas identified by the federal and state government as having elevated poverty, higher than average infant mortality, and where fewer providers agree to practice; • Open to all residents, regardless of insurance status, and provide reduced cost care based on ability to pay; • Tailor services to fit the special needs and priorities of local communities, and provide services based on the advice of local residents, businesses, churches, and other organizations; and • Offer services that help patients access health care, such as transportation, translation, case management, health education, and chronic disease management. Health centers are required by law to provide: • Basic health services related to family medicine, internal medicine, pediatrics, obstetrics, or gynecology; • Diagnostic laboratory and radiology services; •...
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...Are Doctors accepting Medicaid Patients as Obama has Signed the Affordable Care Act Rider University 2083 Lawrenceville NJ 08648 5/2/2013 Rider University 2083 Lawrenceville NJ 08648 5/2/2013 Arunabh Sinha Arunabh Sinha Abstract On March 23, 2010 President Obama signed into law the Patient Protection and Affordable Care Act (PPACA), also known as Obama Care. As a direct result of this there are going to be more people on Medicaid and also more “baby-boomers” are going to be turning sixty-five thus qualifying for Medicare. Although fewer doctors are accepting government insured patients! This paper will research the number of doctors accepting governmentally insured patients and also if there is a shortage in the number of providers as the PPACA goes into effect. With data provided from the American Medical Association (AMA), Center for Disease Control (CDC), and other academic journals an evaluation is going to be made of if there is enough doctors to meet the demand of newly insured patients in the US. Issues of access and quality of care will also be addressed in this paper. Are Doctors accepting Government Insured Patients as Obama has Signed the Affordable Care Act On March 23, 2010 President Obama signed into law the Patient Protection and Affordable Care Act (PPACA), also known as Obama Care. As a direct result of this there are going to be more people on Medicaid and also more “baby-boomers” are going to be...
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...of these plans are similar in some ways while others are completely different. When you are trying to decide which one is best for you, it is always good to compare them. The Indemnity Plan lets you choose any provider unlike the others where you either have only HMO providers or you have to select a network or out of network provider like you have to with a PPO, POS, and the Consumer-Driven Health plan. With the Indemnity Plan you do have higher costs just like you would with a PPO but you also have deductibles, coinsurance and preventative care is not covered unlike the PPO, HMO, POS, and Consumer-Driven Health Plan. The Health Maintenance Organization (HMO) only allows you to choose HMO network providers. Your primary care physician manages your care. You will also have a low co-payment just like you would with a POS plan. HMO’s have limited providers in their plan but they do cover preventative care unlike the Indemnity Plan. Also there is no payment for out-of-network...
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...are obvious. If allowing for a broader discussion the actual school prerequisites for the assignment might appear diminished. Taking my chances (and the liberty) I decide to trot into healthcare territory with the attempt to highlight its weaknesses, show how it works, all in 6 pages. This presentation will allow the reader to identify with our main character Dr. DoRight, President of the Universal Human Care Hospital, whose decisions are inherently driven by forces unseen and ambiguous to most stakeholders of his hospital. Now this gives the opportunity to define stakeholders within the healthcare system, of which his hospital carves out a formidable part. Hospitals, doctors’ offices, and pharmacies are usually called providers and while to many they represent the “healthcare system” they really represent the tip of the iceberg next to myriad of agencies being more or less integrated as cogs in a massive industry. Therefore a simplified but complete list of stakeholders would read like this: Patients needing medical care directly paying copay to providers, providers offering care, insurers offering “health plans”, employers purchasing these health plans options and offering them to their employees, Government paying providers under Medicare and Medicaid, Health Maintenance Organizations or HMOs (in some cases PPOs) forming contractual bonds between providers and payers, and finally brokers who give advice on available policies. (KhanAcademy, 2011) The...
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...Health and wellness in the workplace Octavio Ponce COMM/112 September 18, 2012 Karen Hamilton Health and wellness in the workplace Health and wellness programs in the workplace can greatly benefit the company and their employee’s at personal and business levels. It is no surprise that a manufacturing company cannot run an efficient business without their employees being present at the job site. However, with health cost steadily keeps rising and costing the company lots of money, they cannot afford to lose employees for health reasons. Today, employers are suffering more than ever of losing money, not just because of the economy but also of their employees. Employees are being absent from work due to their poor health and lifestyles. Employers are implementing wellness programs to help employees get familiar with other options in changing their lifestyle. The question the employers should be asking is; are we doing enough to ensure the health of their workforce? The majority would simply say; they don’t know. Today, more employers are implementing wellness programs to assist their employees, who aim to better the current health status of the employee and also reducing costs to the company. Encouraging employees is a top priority to start a wellness program on the right track, it is not easy to change employee lifestyle like increasing physical activity, eating habits, reducing stress, and ceasing tobacco use (Lastowka, 2011). The link between the health of the employee...
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...this recommendation you will find a (DCF) discounted cash flow, this will determine whether or not the post-merger company will have the ability to overcome any opposition that be in question. I will also be discussing the proposed strategy that we intend to take, should we agree to the merger. We will explore what works well for each organization and the best way to combine those efforts to maximize on continued growth for the organization. We here at Merck, being the world’s largest drug manufacturer and leader of research and development efforts, have determined that there has been tremendous growth in the area of managed care. Medco is the leading prescriptions benefits Management Company and marketer of mail order pharmaceuticals. It is noted that, experts predict that “90% of Americans will have drug costs included in some kind of managed health care plan, and 60% of all outpatient...
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...Managed Care Staci Berry MHA614 Policy Formation & Leadership In Health Organizations Instructor: Judy Roberts April 2, 2013 Managed Care In this paper we will discuss managed care. We will find and discuss the definition of managed care. This paper will also explain the different types of managed care plans that are available to Americans. This paper will provide examples of the different types of managed care plans available. It will also explain how each plan works. We will also talk about why rising exposure to health care costs are threatening the well-being of American families. According to Harrington and Estes, managed care is a term that has been overused and really does not have a specific meaning. “Originally, it referred to health care delivered with a capitated financing mechanism. Then it included health care delivered through contracting networks. Currently it refers to most any health are delivery that is different from fee-for-service health care delivery” (Harrington & Estes, 2008 pg.42). When dealing with managed care usually there is a panel of providers that the individual can use. If they go outside of this panel they will be more likely to have to pay a higher copayment or deductible. Some characteristics of a managed care health plan delivery system include: “explicit standards for the selected health car providers, it also puts emphasis on preventive care, as well as provides financial incentives to ensure the use of the...
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...Contents…………………………………………………………………………………..2 Introduction to Managed Care and the Pros………………………………………….3-4 • Types of managed care • How managed care is governed Cons of Managed Care…………………………………………………………………………..4-5 • Why is there a need for managed care Conclusion……………………………………………………………………………………………..5 References……………………………………………………………………………………………..6 Health insurance plans that contract with health care providers and medical facilities to provide care for members at reduced costs are called managed care plans. There are three different types of managed care plans, and can benefit individuals in different ways depending on the coverage options they are looking for. Like a lot of different things, managed care can have positives and negatives. Managed care is where health insurance companies have contracts with health care providers and facilities to provide care to patients at a reduced price. These providers make up the plan's network. How much of your care the plan will pay for depends on the network's rules and if the provider is in that specific network. There are three different types of managed care; HMO, PPO, and POS. HMO is a health maintenance organization and this is where they usually only pay for care within that network. Some insurance companies like Summa, Anthem Blue Cross Blue Shield, and Medical Mutual offer HMO plans. A PPO is a preferred provider organization which is where they usually pay more if you get care within the network, but they still pay...
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...|Accountable Care Organization (shared savings) |Primary Care Medical Home |Bundled Payment |Partial Capitation |Full Capitation | |Strengths and Weaknesses |-Providers are accountable for total per-capita costs. -Patient “lock-in” is not required. - Reinforced by other reforms that promote coordinated, lower-cost care. |-Supports coordination of care between physicians. -Does not require accountability for total per capita cost |-Promotes efficiency and care coordination. -Does not require accountability for total per capita cost |- Combines FFS and prospective fixed payment, providing “upfront” payments that can be used to improve infrastructure and process. - Accountability only for services/providers. - May be viewed as risky by many providers. |- Provides “upfront” payments for infrastructure and process improvement and makes providers accountable for per-capita costs. - Requires patient “lock-in.” - May be viewed as risky by many providers. | |Strengths for Primary Care |YES - Provides incentive to focus on disease management. - Additional support by adding medical home or partial capitation payments to primary care physicians. |YES – Changes care delivery model for primary care physicians, allowing for better care coordination and disease management |YES, indirectly – Bundled payments result in greater support for primary care physicians |Yes – Partial Capitation allows for infrastructure and process improvement, creating a new model for primary care delivery...
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...dependent on a ventilator for breathing and a feeding tube for nourishment. The accident left her paralyzed and her awareness is uncertain because she communicates by nodding her head. The patient’s physician Dr. Bob Pritchard, who is in charge of Lydia’s care, is not very confident about her recovery. Lydia’s husband, Mr. Bevin, says his wife would not want to be kept alive in this fashion and does not know the location of her advance directives. Unfortunately, Lydia’s mother, Eileen Redfield, believes in miracles and end of life is not an option for her. The battle of emotions between mother and husband has Dr. Pritchard in the middle. Mr. Bevin states that before their marriage Lydia had written an advance directive but he was unable to locate the document. Without knowing her advance directives, it became the responsibility of her love ones to make the final decision about continued care or termination. For someone as critical as Lydia, end of the life decisions are not an option for Lydia’s mom. On the other hand, her husband thinks that Lydia should not have to suffer in this way and agrees to end life. It is not easy for anyone involved and having to make an ethical decision to end life. The end-of-life critical care cases tend to experience the most emotional turmoil, and are the most difficult. The CEO of the hospital, Felicia Larue, has asked for a briefing on the status of the patient and alternative methods to protect the patient’s rights and minimize the hospital’s...
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...Organizations (HMO’s), and Preferred Provider Organizations (PPO’s) are the primary methods of seeking medical care. Each form of healthcare has their distinct advantages and disadvantages. Each one also offers their own unique brand of healthcare. Being able to establish a clear cut path for the reader to follow is the primary objective of this paper. The secondary objective is to provide desirable and qualitative information to better equip the reader for making an informed decision. To better understand these forms of healthcare this paper will systematically move through each organizational structure examining management style and methods of care. Understanding these organizations will bring forth a new era in healthcare in the perspective of the patient and family members. Further providing legitimacy to the healthcare system and improving the image of Home Healthcare, HOM’s, and PPO’s. This paper has provided examples of different forms of healthcare. These forms of healthcare are Home Healthcare, Health Maintenance Organizations, and Preferred Provider Organizations. Challenges face each organization. Many of the organizations provide a different balance of healthcare thought and theories to approaching patient care. The key factor for any patient to consider is what the organization provides for them and how much is the patient willing to spend on their health care. Additionally, continuous management of personnel and patient loads will help any of these forms of healthcare...
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...beneficiary from financial costs associated with health care. The main aspect of indemnity health insurance was coverage for illness not necessarily for prevention or wellness. The insurance company would decide the maximum amount of billing charges and the provider was able to bill the beneficiary anything the insurance did not pay for. In some cases, the insurance company would pay the beneficiary and the beneficiary would have the responsibility of paying the provider. On the other side of the spectrum is Health Maintenance Organizations. Health Maintenance Organization is a type of managed care organizations that provides a form of health insurance coverage that is fulfilled in hospitals, doctors, and other providers under contract. HMO is basically having the beneficiary pay for their coverage in advance rather than paying for each health services. Initially, the beneficiary would have to pay a price of a monthly premium and then HMO will offer a range of benefits from preventive care to full coverage. The main difference between HMO and PPO is the freedom of choice. HMO allows you to see doctors only within the HMO’s network but with PPO you can choose to see any doctor you wish but the coverage will result in higher out-of-pocket costs like copays and coinsurance. In the middle, Preferred Provider Organizations (PPO) are contracted between employer health benefit plans and health insurance carriers in order to purchase health care services for covered beneficiaries from a selected...
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...Table of Contents Executive Summary 2 Introduction 5 Company Background 7 Quality Intitiatives 9 Key Observation Points 11 Comparative Analysis 12 Concluding Remarks 13 Future Recommendations 15 Appendix 17 References 21 Executive Summary Coventry’s roots can be traced back to November 21, 1986, the date the company’s predecessor company, Coventry Corporation, was incorporated. Coventry Health Care, Inc. became a public company in 1991, and is currently listed on the NYSE with ticker symbol "CVH". Since the company’s inception, the building blocks of “The Coventry Model” have remained financial discipline and service excellence. The company’s senior management team has long understood those two objectives need not be mutually exclusive. As an organization, our long-term success depends on the ability to translate our commitment to affordable and accessible health care into real change. We look to four principles to guide us as we strive to provide exceptional value for members, employers, and providers: Easy and Simple Experience Everyone at Coventry is uncompromising in their commitment to ensure that all our customers have an easy, simple, and productive experience – whether enrolling as a new member, refilling a prescription, or filing a claim. Operational Excellence We pay fanatical attention to operational excellence, continually refining the advanced platforms and processes that are essential to what we do: delivering...
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...Cooper-Pearson is a very well respected sports marketing firm, however, they do not offer adequate or affordable insurance or the options that comes with it. There are insurance programs like HMO, PPO, and an indemnity service. In comparison, all have premiums that have to be paid. All are accepted by hospitals. And all are optional. The two that are popular for selection is either HMO or PPO. On the contrast, HMO contracts have health care professionals and facilities that create a “provider network”. When choosing HMO typically you will pay a small amount as a co-payment when visiting a hospital or physician within your network. However, HMO is the least flexible. And you have to choose a primary care provider (PCP) with this option. On the other hand, PPO contracts have contractual agreements with health care providers. And it creates a “provider network”. But unlike HMOs, PPO health insurance will cover some-but not all-of the cost of care administered by out-of-network providers. In addition, the advantages and or disadvantages of having either plan will solely depend on one’s individual situation. Furthermore, PPOs do not need to select a PCP. And unlike HMO, PPOs will generally pick up at least some of the cost of out-of-network cost. All these factors are essential when selecting an option that is suitable for your needs. Cooper-Pearson has been around for many years now and they only hire the brightest men and women from colleges and universities in the United States...
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...Quality in Health Care Shanna Marie Fulwood HCA 305 Tessa Guisinger September 17, 2012 Healthcare has become a major issue within recent years. “In spite of its long history and common years the US healthcare system has a complex puzzle to many Americans” (Sultz and Young, 2010, pg XVII). Obama has tried recently to provide access to every individuals they can have some kind of medical care. His new healthcare bill says that everyone has to have medical insurance. This was done because so many Americans are without health care coverage. Now that is mandated we have healthcare coverage what our options? One of the major concerns that we face and always have faced is the quality of care we received. Anyone deserves quality out of the healthcare system. Fortunately there are ways to measure healthcare quality. These tools are mostly used by the professionals. Some questions that will be answered here are how does the quality of healthcare in the United States compared to the quality of care and other industrialized nations; how can an acceptable quality of healthcare be assured for all; will providing data in areas such as patient outcomes, compliance with national standards for preventive and chronic care, and comparative cost to the public be an acceptable measure of healthcare delivery outcomes; the physicians believe that only physicians could and should judge the quality of medical care, they found participation in such hospital peer review activities and most disagreeable...
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