Colorado College CB healthcare discussions

Content Type

User Generated

User

Ohex

Subject

Health Medical

Description

Please complete all parts

Part 1

Discuss at least 1 reason why the managed care delivery model was created.
Describe at least 2 different types of managed care, including their differences.
Identify at least 1 advantage and 1 disadvantage of the managed care model.

NOTE: Use at least two scholarly references and cite using APA format.

Part 2

Within the Discussion Board area, write 250-350 words that respond to the following questions with your thoughts, ideas, and comments. This will be the foundation for future discussions by your classmates. Be substantive and clear, and use examples to reinforce your ideas.

How healthcare services are provided is constantly changing. While historically, emergency departments (ED) was physically located within the hospital building, the standalone Emergency Department also referred to as the Free Standing Emergency Department (FSED) has become a new model for delivery of emergency services within communities. Consider yourself in the role of a consultant to a healthcare organization, financial manager, or ED administrative director. You have been asked to provide the CEO and leadership with pros and cons of establishing a Free Standing Emergency Department. You are aware of the news stories about these types of facilities, and you will want to review The Washington Post article at this link as you prepare your review.

Include in your discussion:

Differences between off campus emergency departments (OCEDs) and independent free standing emergency centers (IFECs). What would be the advantage to the healthcare organization of an OCED?
How would services provided be reimbursed either by private insurance or Medicare/Medicaid?
What are the advantages or disadvantages to the community of an FSED? Would members of the community favor an OCED or an IFEC?
Why are most of the FSEDs located in Texas, Colorado and Ohio?
Based on your research and the news stories about FSEDs, what would you recommend to the CEO and Board of Directors?

NOTE: Use at least two scholarly references and cite using APA format.

Part 3

Describe two reimbursement models and the role of the physician in each model.
How do government and private insurers influence how physicians practice today?
Why is accurate and complete documentation in the electronic health record important to reimbursement and quality of care?
What other members of the healthcare team who do not provide direct care to patients contribute to cost containment and delivery of healthcare services

NOTE: Use at least two scholarly references and cite using APA format.

Part 4

Review and reflect on the knowledge you have gained from this course. Based on your review and reflection, write at least 3 paragraphs on the following:

Identify one challenge you see in the U.S. health care system today. What healthcare organizations/departments are impacted?
Identify one government agency and its role in meeting the challenge?
Considering your career goals in the healthcare industry, how would your role as a member of the healthcare team and your team be involved in meeting the challenge?
What did you learn in this course that was most surprising or unexpected from when you started the course?

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Explanation & Answer

Attached.

Running Head: HEALTHCARE DISCUSSIONS

Healthcare Discussions
Institution Affiliation
Date:

1

HEALTHCARE DISCUSSIONS

2

Part 1
In healthcare, insurance is every critical part of the provision of services in the hospital
setup. Most of the Americans have entered into contracts with most of the medical facilities to
help them access medical services through correctly guided models popularly known as manage
care models. The members of the specific models can be able to access medical services at a
reduced cost. The managed care models follow particular rules of the agreement, and it is
through these rules that the payment approvals. In essence, the managed care models tend to be
flexible and at the same time costs less mainly for the restricted plans. However, for a flexible
program, there can be some added cost of healthcare.
The most common care plans include the Health maintenance organization, commonly
referred to as HMO. This strict model usually forwards the payment for care within a specific
network. In such a model, the subscriber chooses their primary doctor through whom all the
medical connections and the cost of care will be coordinated. The second model of care is known
as the preferred Provider organization or the PPO model, which is flexible. Such a model will
always attract more pay if a person gets the required care within a network (Wagner and
Kongstvedt, 2013). Whenever the consideration is received outside the stipulated network, it
means, therefore, a member will have to pay part of the cost of care. Lastly, there is the point of
service or the POS model, which helps a member to choose any of the two models whenever
they need the care.
With the managed care model, it is simple and guaranteed that a member will receive the
required services at any given time within the network. The members, therefore, enjoy the peace
of mind knowing that there will certainly get the required care. The managed care model

HEALTHCARE DISCUSSIONS
involves strict rules that limit the choice of doctors. Anything done outside the stipulated
network will attract extra cost.

3

HEALTHCARE DISCUSSIONS

4

Part 2
As a consultant, I can confirm that there are some significant changes in the provision of
healthcare. We have moved from the past where the emergency department was built within the
hospital. The department is not freestanding emergency department which has been detached
from the hospital. The management of every health care center has to understan...