Question

Assignment 2: Ethical Factors for HMO

You are the HMO Vice President of Operations for NuCare HMO. The HMO President tells you that the board is considering discontinuing Medicare affiliation. The board wants to know how this will impact their membership in rural areas where there is no other HMO that is affiliated with Medicare.

The president directs you to create a five- to six-slide PowerPoint presentation to present to the Board of Directors. The presentation should briefly outline what the likely outcome would be for rural membership if the HMO stops attending to Medicare patients. Include the following considerations in your presentation:

The difficulty members may face in finding new care options

The concerns that may need to be addressed for members seeking new care options

Whether members will be able to acquire Medicare gap insurance

Make a final recommendation as to whether NuCare should discontinue its Medicare affliation.

Use headings, bold, and bulleted lists in your presentation. Use the notes section in PowerPoint to clarify your responses or add additional detail where warranted.

The attached article discusses what happens to patients when their HMO decides to discontinue serving Medicare patients. The article contrasts the different experiences among people who live in areas where there is a choice of another Medicare HMO against the experiences among people who live in areas where there is not another HMO.

Source: Booske, B. C., Lynch, J., & Riley, G. (2002). Impact of Medicare managed care market withdrawal on beneficiaries. Health Care Financing Review, 24(1), 95-115.

Submit the presentation to the Submissions Area by the due date assigned.

Assignment 2 Grading Criteria	Maximum Points
PowerPoint presentation clearly and accurately outlines the likely outcome for rural membership if the HMO stops seeing Medicare patients.	20
Discussed difficulties that members may face in finding new care options.	20
Discussed the concerns that may need to be addressed for members seeking new care options.	15
Discussed whether members will be able to acquire Medicare gap insurance.	15
Made a recommendation on whether NuCare should discontinue its Medicare affiliation.	20
Wrote in a clear, concise, and organized manner; demonstrated ethical scholarship in accurate representation and attribution of sources; displayed accurate spelling, grammar, and punctuation.	10
Total:	100

Note: All discussion assignments in this course will be graded using a rubric. Download the discussion rubric and carefully read it to understand the expectations.

Answer 1

PAGE 1

-Maximum health upkeep administrations (HMOs) that contribute in Medicare suggest extra benefits external of the steady Medicare benefit package. Extra benefits commonly include low copayments, prescription drugs, unlimited hospitalization, and preventive services.

-Many beneficiaries have come to rely on the extra benefits they receive from their HMO, chiefly medicine drug attention.

-Substituting these aids through Medigap insurance is characteristically much overpriced, and may be too affluent for some. Linking additional HMO or going to FFS may also strength numerous recipients to variation medics, making displeasure and unruly existing designs of maintenance.

-So, there has been apprehension amid policymakers about the influence of the recent HMO extractions on the recipient populace.

PAGE 2

-There were two preceding national determinations precisely intended to evaluate the impression of the plan removals and facility area discounts on recipients.

-An account founded on the review results designated that though most dis-enrollees managed comparatively well afterward their HMO removed from Medicare, many experienced a reduction in supplemental benefits, an increase in premiums, and/or disturbances in their care measures.

-Difficulties were excessively knowledgeable by restricted recipients, racial and ethnic factions, the poor and near poor, and those reportage reasonable or poor health.

-The additional effort contained of a telephone review of numerous hundred recipients showed by the Department of Health and Human Facilities' Workplace of the Inspector General.

-The review enclosed enrollee announcement; info and help in traveling new assurance choices; what choice recipients designated; variations in welfares and prices; glitches met; and gratification.

-The Workplace of the Inspector General review was showed double, next the January 1999 and January 2000 extractions. These reviews did not find plain glitches, but no examines were complete for susceptible populaces.

PAGE 3

-A third learning convoluted a nationwide sample of over 6,000 Medicare beneficiaries of whom 425 remained in M+C tactics that stationary portion enrollees at the end of 1999.

-A new magazine from this education précises the changes amid tactics that remove from M+C and those that continue.

-Withdrawing tactics incline to have inferior employments, offer less substantial profit correspondences, had fewer steady welfares, and confronted rivalry glitches inside their marketplaces.

PAGE 4

-The physiognomies of instinctive dis-enrollees existing in parts with and deprived of a select of another HMO were moderately comparable with one chief omission: only 3 out of a hundred of recipients pretentious by the 2001 plan removals with a high-quality of additional HMO lived in non-metropolitan regions, while 34 out of a hundred of recipients without additional HMO option existed external of metropolitan zones.

-This alteration climaxes the continued difference noted in selections obtainable to municipal and non-metropolitan recipients.

-In difference to the resemblances amid recipients in the other two example layers, recipients in the ESRD sample were fairly different from those without ESRD: recipients with ESRD were more possible to be feminine, black, in fair or poor well-being, and had to have been hospitalized throughout the past year.

PAGE 5

-The answers display that there are approximately clear info and understanding openings amongst recipients, chiefly those in more susceptible subcategories, concerning the choices obtainable to them and the insinuations of plans retreating from the Medicare Program.

-Literatures from the non-renewing tactics were by far the maximum recurrent first foundation of info about the plan removal for the mainstream of dis-enrollees.

-The broadcasting was the following most recurrent foundation of info excluding for those in the more susceptible subcategories such as the less cultured and all ethnic collections additional than white non-Hispanic.

-Restricted recipients who were in the all additional racial cluster and in reasonably to poor health were fewer expected to designate they established sufficient data about the strategy departures.

-These same collections were fewer expected to be conscious of the obtainability of additional health insurance.

-Other clusters who were a reduced amount of conscious of additional insurance choices comprised those recipients less sophisticated who were in the all other racial collection and less educated recipients were also less probable than other recipients to comprehend what would occur to them with admiration to health care attention when their plan left the Medicare Program.

-About 4 in 10 recipients in the all other ethnic group or recipients with less than a high seminary teaching unstated what would occur likened to one-half of all recipients.

-Beneficiaries' information of consuming enough info were obviously related with their empathetic of what would occur when their plan removed and consciousness of additional health assurance choices.