Question

Think about a provider organization that you are familiar with and identify the responses that it has been using. Why are they responding that way? Is it a good way to respond and for whom? What could they do to respond more effectively?

Answer 1

Provider Organization:
Health Maintenance Organization:
   In the US HMO(Health Maintenance Organization) is a medical insurance group that provides health services for a fixed annual fee..This organization provides managed care for health insurance,self-funded health care benefits plans,individuals and other entities...HMO require members to select a primary care physician(PCP)..Doctors are gatekeepers for this,it also manage care through utilization review..It means they monitor doctors and their services..HMOs provide preventive care for a patients for a lower copayment or for free..HMO organization providing equal access to health care services in exchange for members with in a covered network of providers who have pre-negotiated for lower cost services..it provides quality of care for the patients..
   HMO responding in that way inorder to meet high standards and join the network,to maintain excellent care ratings..So they can satisfy the customers..in many ways HMO supports preventative wellness care..Expensive medical claims are controlled by an HMO approval process before they take place it protects consumers from fraud..In health care market traditional fee-for-services health care plans remains steady for the last 2 decades..The US department of labor advises fee-for-service plans provide 96% of health care plans..it provides employee benefit plans,health insurance and maintaining quality of care for customers..HMO responding in a good way for the consumers for all the health plans and quality of care..
   American health care system would surely work better and effectively if all physicians responded to new evidence on what kinds of care work better as soon as that evidence is definitive..Physician response to evidence would be and effective way to control cost with lot of support..employee role with more effective care in the health care system to control the cost and improved outcomes..The underlying fragmentation of health care system providers do not have the payment support they need to communicate and work together effectively to improve patient care..Reforming health care delivery system is must to improve the quality and value of care to address escalting costs,poor quality and increasing numbers of americans without health insurance coverage..