In your own words, explain open- and closed-panel health maintenance organizations (HMOs) and the continuum of managed care. Share an experience about either panel HMO or the continuum of managed care.
Open panel health maintenance organisation:
Require individuals physician participates in the program through their membership in an independent practice association.
Physician who participants in open panel association can see patient who not with organization.
An HMO that allows insured member to access provider outside the panel or network with some restriction like higher cost.
Closed panel health maintenance organization:
Closed panel HMO us a manager plan has exclusive arrangements with physicians that blocks them from seeing patients from another managed care organization.
HMO pay only for health services provided by physician or its network.
Experience in HMO:
1. HMO enter under medicare competition demonstration.
2. Its highly useful for me as a physician I can able to get all patient information as well I can get outside information also.
This HMO highly useful for me as a physician.
In your own words, explain open- and closed-panel health maintenance organizations (HMOs) and the continuum of...
you have learned about the liability of MCOs (managed care organizations) such as HMOs (health maintenance organizations) and PPOs (preferred provider organizations).where does the liability lie for the managed care organization when the MCO personnel make decisions about insurance coverage for hospital stays? Please do not limit your analysis to length of stay, but consider other scenarios associated with MCO decision making such as approval or denial of medically necessary treatment (or limitations of treatment) as well, and share your...
A random sample of 15 health maintenance organizations (HMOs) was selected. For each HMO, the co-payment (in dollars) for a doctor's office visit was recorded. The results are as follows: 9, 12, 8, 12, 7, 5, 5, 6, 6, 11, 12, 11, 10, 8, 10 Send data to Excel Under the assumption that co-payment amounts are normally distributed, find a 90% confidence interval for the mean co-payment amount in dollars. Then complete the table below. Carry your intermediate computations to...
Risk-Based Reimbursement For your assignment, a primary care physician is often reimbursed by Health Maintenance Organizations (HMOs) via capitation, fee-for-service, relative value scale, or salary. Capitation is considered as a risk based compensation. In an effort to understand the intricacies involved with physician reimbursement, particularly in an era of health care reform, identify and interview an expert in the field, such as: Hospital Administrator Managed Care Organization (MCO) executive Health care Consultant Legal Professional Assumption: MCOs use risk-based reimbursement for...
In your own words, describe how housing factors into the continuum of care for the elderly. Why is it important? What are the various options? Which seems to you to be the most effective and why? Your post should have a minimum of 150 words
Select a health care facility you are familiar with. In your own words, explain how you think they define quality and how it is controlled? (about 200 words)
Describe in your own words what continuum of care means to you. Why is it important to consider? What implications does it have for staff, providers, patients, or families? Your post should have a minimum of 150 words.
In your own words, describe the reasons why hospice is an important component of the long-term care continuum of care and include the perspectives of providers, patients, and families. 1) Seeing that wellness has been a health concept for years, describe in your own words why wellness is an important, and sometimes overlooked, foundation to provision of long-term care. 2) In your own words, describe how housing factors into the continuum of care for the elderly. Why is it important?...
Describe in your own words what continuum of care means to you. Why is it important to consider? What implications does it have for staff, providers, patients, or families?
Comparing Private Insurance P Alison purchases health insurance coverage for herself and her spouse. This is an example of a group urance plan Indemnity, or fee-for-service, plans and managed care plans cover medical expenses if you are sick or injured, but in different ways. The following questions examine the general differences between the two plans. Taking a closer look at how these plans provide coverage will help you begin to customize a health care plan that best suits your requirements....
In your own words, explain why employer-purchased health insurance results in more comprehensive health care coverage. What are some of the arguments in favor of eliminating or placing a cap on the tax-exempt status of employer purchased health insurance? What are some of the consequences of greater comprehensiveness of employer-purchased health insurance? What are the differences between community rating and experience rating, and what are some consequences of using community rating? What are some reasons the Affordable Care Act has...