Question

LP05 Assignment: Medicaid and HMO Paper

HA3120D - Essentials of Managed Care

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

1.SHOULD MEDICAID AND HMOs JOIN FORCES ?

MEDICAID -Medicaid is a public health insurance program in the united states that provides health care coverages to low -income families or individuals .It covers doctors visit ,hospital stays ,long term medical care ,custodial care ,and other health related cost .

HMO-HMO means HEALTH MAINTENANCE ORGANIZATION HMO plans offers a wide range of health care survices through a network of providers who agree to supply services to members .

SHOULD MEDICAID AND HMO JOIN FORCES ?-HMO has the most restrictive form of health insurance ,whereby they restrict their subcribers choices doctors and hospital in their network ,i think if the HMOs join forces it would help if at first they are given choices of atleast two or three HMOs to choose from ,in return this should help medicaid /medicare patients have a choice of choosing their provider.

2.WHAT ABOUT MORE (HMO)

The health care financing administration (HCFA)has encouraged health maintenance organization (HMOs)to provide medicaid coverage to enrolled beneficieries for fixed prepaid premiums.HMO provide care of comparable quality to that deliverd by free for survice (FFS)providers using fewer health care resources .

Do HMOs reduce service utilization -The premise of the medicaid risk program is that HMOs can prosper while providing medicaid coverage for less money than the FFS sector,primarily by reducing unnecessary service use and ineffiency in the delivery of health care .

HMOs reduce hospital days -HMOs shortened the average hospital length of stay by 1.5 days (16.8 percent)relative to FFS ,but did not affect the number of hospital admission .

Effects are greatest for the seriously ill-HMOs increased the use of some services by beneficieries whose health was poorest,but they reduced the intensity of services more for this group than for other benefieries ,example ,Although HMOs had no effect on hospital admission overall,they increased the probability of admission of admission for enrolles in poor health and those with functinal impairments.

Mnimize administrative burdens- HCFA could also look for ways to minimize the administrative burdens that risk programs rules and requirements impose on participating plans .

conclusion

with a careful planned package of changes by HCFA and continued efforts on the the part of HMOs ability to deliver medicaid services more effiency could bring saving to HCFA ,benefieries ,and HMOs.

3.WOULD THE STATE SAVE MONEY BY ENROLLING MEMBERS IN AN HMO?

The programe will save less than the intended 5 percent and may actually increase cost to HCFA(Health care finance administration ).If HMOs experience adverse selection HCFA will save more than 5 percent ,but the risk plans may lose money and drop out of the program. The evaluation measured the extent of favorable or adverse selection and estimated the effects of the risk program on cost to HCFA.

4.WHAT WOULD HAPPEN THE QUALITY OF CARE

The quality of care deliverd by HMOs has the potential to be better or worse than that rendered by FFS providers .In responding to the financial incentives to provide care more efficiency ,HMOs may restrict services too much ,leading to lower quality care .

The impacts of risk plans on quality of care by :compairing the survices received by by the HMO and FFS patients who were hospitalized for colon cancer or stroke and there outcomes ;compairing the ambulatory care received by HMO patients for three chronic problem (joint pain,urinary incontinance ,and recurring chest pain );and compairing the satisfaction of HMO enrolles and non enrolles with various aspects of care they received .

Examples -HMO stroke patient received significantly less physical therapy ,in addition to providing less resources intensive care while a patient is in the hospital ,HMO also discharged both stroke and colon cancer patients to lower cost settings .