Question

Please answer these questions for this case provided below:

- Why would it make sense to become a network HMO?

• Did it make sense for Geisinger to support the patient-centered medical home transition?

• Could an independent practice afford to become a patient-centered medical home?

• Why is Medicare sponsoring patient-centered medical home demon- strations?

• How would a 6 percent reduction in hospitalization rates affect hospitals?

The conflicting incentives of FFS and capitation present significant problems for integrated health systems like Geisinger Health System of central Pennsylvania. Indeed, after its merger with Penn State Health col- lapsed, many were concerned about its viability. Geisinger faced losses in its hospitals and physician group, and its health plan was not doing well (Goldsmith 2017). Geisinger's turnaround involved two strategies: increasing the share of physician compensation in the form of FFS payments and imple- menting a robust network of patient-centered medical homes to limit low- value care (healthcare offering little or no clinical value or even having potential harms greater than its benefits). The change in physician compensation allowed the creation of a broader network and rewarded higher volumes. In essence, Geisinger became a network HMO (an HMO hav- ing a variety of contracts with physician groups, IPAs, and individual physicians; it may also own hospitals and employ physicians). Geisinger had two major advantages. Its Medicare Advantage plan was profitable, and its strong market position allowed it to negotiate good rates with local insurance plans. Those high rates gave it the resources necessary to transform its primary care practices.

Answer 1

HMO(Health management organization) plan provides Medicaid and private insurance health care costs. HMO provide access to certain doctors and hospitals with their network. This network has provides with lower rate plan and with quality standards. It has low monthly premiums with less out of pocket money for the patients. It saves money on health care costs, it will have nor deductibles.
Patient-centered medical homes as a primary care system provide better care with lower cost per capita focus on effective care for all patients. Geisinger support PCMH for limited low-value care.
Independent and small practices provide fewer benefits for transforming PCMHs. large practice benefit PCMHs. small and independent practice can not able to afford PCMH components like care coordination and management with shared decision making.
Medicare practice offers supplementary payments to primary care practice to become PCMH. Demonstration payment helps practice pays for improvement capability. this supports the care delivery. demonstration produces a gross sample for medicare. Medicare pays higher demonstration payment for PCMH.