Question

Medicaid and HMO Paper Directions

Review the following video: Medicaid and HMOs Video.

• Assignment: Should Medicaid and HMOs join forces?

• Write a 2 – 3 page paper in what you find out about whether or not the HMO’s representative claims were correct. Does an HMO, enrolling Medicaid patients promise; one, cost efficiency and two improvements in quality of care? One site you can get started is The National Bureau of Economic Research. There are many other sites you can look at to get data about this. So that’s your assignment. Good idea? Bad idea and why? Back it up with some good data. That’s all there is to it. Good Luck!”

Consider:

• Would the state save money by enrolling members in an HMO? How so?

• What would happen to the quality of care? Give possible examples. Cite your references.

Answer 1

Managed Health Care Plan: A group of medical providers contracts with a group to provide medical care for its members at prices both agree to and are lower than the traditional cost of insurance

- HMO is the original managed health care model

• HMO saves money by enrolling the members by-

-Before an HMO may offer coverage and benefits to the public, the HMO must obtain a certificate of authority from the state's dept. of insurance
-HMO owns or contracts with a clinic and staffs it. Subcontracts with a hospital
-Members may only use the group facilities and primary care providers (PCPs)
-Only the PCP can refer a patient to a specialist or hospital
-Provides free preventive medical care (annual physical exams, immunizations, etc.) in an effort to identify and treat problems early (promoting health and saving money)
-HMO has control of both of the producers and purchasers of health care to contain costs more efficiently
-Each member pays a specified monthly flat fee for membership
-Each member must be provided with a description of the specific procedure for lodging and resolving any complaints about the plan

- HMO Organization: Pre-paid service organizations

Organized in 4 ways: staff, group, network, and individual practice association model.

Quality of care:

-HMO's are designed to deliver quality of health care to a designed population in a cost effective manner, through health care providers paid either a fixed budget or discounted fees.

-They use a value- driven system of managed care to provide affordable Care services.

-Improves service quality

-Improves population health

-Increase preventive services

-Quality and accessibility of health care.