Module 3 – Case
MANAGED CARE, ACCOUNTABLE CARE ORGANIZATIONS, HEALTH CARE CONSUMER PLANS/MODELS
Assignment Overview
There are various types of plans consumers can select. MCOs, HMOs, PPOs, POSs, or ACOs are the most common ones; however they all supply various benefits and drawbacks. Consumers (patients) have the right to choose the type of plan that best fits their needs. As a health care leader, it is vital that you understand the differences in these plans. In addition, in a health care environment where there are plenty of options for consumers (e.g., providers, medical offices, location, consumer plans etc.), ideally making the “choice” is left up to the consumer’s determination.
Case Assignment
For the Module 3 Case Assignment, conduct additional research as needed and complete the following:
- Part 1 – Comparative Chart:
- Part 2 – Designed an Application (App):
- In the world of technology, the “consumer choice” is often swayed by their research efforts or applications. In at least 2 pages, design an app to assist consumers with making a choice between the various consumer plans. Be creative and detailed about your application. Explain the contents of the application that you create and why you feel it would be beneficial to consumers.
In your scholarly paper, you should include an introduction and conclusion paragraph.
Assignment Expectations
- Conduct additional research to gather sufficient information to justify/support your thoughts and analysis.
- Limit your response to a maximum of 4 pages.
- Support your report with peer-reviewed articles, with at least 3 references. Use the following link for additional information on how to recognize peer-reviewed journals. Angelo State University Library (n.d.) Library guide: How to recognize peer reviewed (refereed journals). Retrieved from: https://www.angelo.edu/services/library/handouts/peerrev.php
- You may use the following source to assist in formatting your assignment. Purdue Online Writing Lab. (n.d.). General APA guidelines. Retrieved from: https://owl.english.purdue.edu/owl/resource/560/01/.
- For additional information on reliability of sources review the following source. Georgetown University Library (n.d.) Evaluating internet resources. Retrieved from https://www.library.georgetown.edu/tutorials/research-guides/evaluating-internet-content
Module 3 – Background
MANAGED CARE, ACCOUNTABLE CARE ORGANIZATIONS, HEALTH CARE CONSUMER PLANS/MODELS
Required Reading
Feeley, T. W. & Motha, S. N. (2018). New marketplace survey: Transiting payment models: Fee-for-service to value-based care. Retrieved from https://catalyst.nejm.org/transitioning-fee-for-service-value-based-care/
Haas, S. (n.d.). Health Reform Act: New models of care and delivery systems. Retrieved from https://www.aaacn.org/health-reform-act-new-models-care-and-delivery-systems
Plunkett, L. (2015). Accountable care organizations. New York State Dental Journal, 81(3), 4–7.
Shi, L., & Singh, D. A. (2017). Chapter 9 Managed care and integrated systems. In Essentials of the U.S. health care system (4th ed.). Burlington, MA: Jones & Bartlett Learning. Retrieved from the Trident Online Library.
World Health Organization. (n.d.). Health care delivery models. Retrieved from https://www.who.int/hac/techguidance/tools/disrupted_sectors/module_07/en/index3.html
Wood, D. (2013). Providers getting creative with new healthcare delivery models. Retrieved from https://www.amnhealthcare.com/latest-healthcare-news/provider-getting-creative-new-healthcare-delivery-models/
Videos
Aetna. (2017). What’s the difference between an HMO, a POS, and a PPO? | Health care answers in 60 seconds. [Video file]. Retrieved from https://youtu.be/lvRetvxWjQY
Kaiser Health News. (2015). The ABC’s of ACO’s. Retrieved from https://youtu.be/oV5rxViCf9U
FAIR Health. (2017, November 1). Point of service (POS) (Part 4 of 8)—FAIRHealthConsumer.org [Video file]. Retrieved from
Expert Solution Preview
Introduction:
As a medical professor in charge of creating college assignments and answers for medical college students, it is important to understand the various types of plans that consumers can select in the healthcare industry. This module focuses on Managed Care, Accountable Care Organizations, and Health Care Consumer Plans/Models. The assignment involves creating a comparative chart and designing an application to guide consumers in selecting between the different healthcare consumer plans/models.
Answer to Question 1:
The comparative chart evaluates and discusses the key features, differences, and disadvantages between Managed Care Organizations (MCOs), Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Point of Service Plans (POSs), and Accountable Care Organizations (ACOs). MCOs are a type of healthcare organization that manages healthcare through contracts with providers and consumers. HMOs involve a contract between insurance and healthcare providers, with prepaid care and limited provider flexibility. PPOs allow consumers to see any provider, but with higher costs outside the network. POSs are a combination of HMOs and PPOs, with a primary care provider controlling referrals to other providers. ACOs are groups of providers and healthcare organizations that collaborate to improve healthcare quality and reduce costs. The comparative chart highlights the significant features, differences, and disadvantages involved in each plan, providing insight into choosing the best healthcare plan for consumers.
Answer to Question 2:
In designing an application to assist consumers with making a choice between the various consumer plans, it is important to consider their research efforts or other applications. The application design requires creativity and detail to provide assistance to the consumers. The app should provide information on the benefits, cost, and quality of care provided by each healthcare plan through a user-friendly interface. Additionally, the app should provide updated information on healthcare networks and providers, alongside the services they offer. The app should also show patients an estimate of their out-of-pocket costs in different healthcare plans. Finally, the app should provide ratings and reviews by previous consumers of selected healthcare plans. This detailed application would benefit consumers in choosing the best healthcare plan from a vast range of options available in the healthcare industry.
