GCU The Payer Systems Insurance Continuous & Effective Care Case Study

User Generated

no34

Health Medical

Grand Canyon University

Description

Case Scenario

A patient is confused about how to make payments for a recent visit to urgent care and hospital stay. Her employer-based insurance provider's website allows her to use her HSA account to make a payment online. She uses her HSA debit card to make the payment, but her insurance provider sends her a check instead of sending it to the Tri-City HealthCare Agency. After contacting her insurance help desk via the website, she is told to send the check to Tri-City HealthCare Agency herself. The patient asks the insurance provider's help desk representative why they cannot just make the payments for her. She is told about the various payment types and payers in the health care industry and how the market influences the integrated delivery systems in the industry.

Case Questions

Describe the payer systems mentioned in the case study.

Explain how the market forces have influenced the need for integrated delivery systems.

How might the insurance provider explain the payment system it utilizes for its clients? Explain if this method is effective or not for the insurance provider's clients.

What has been the most significant legal and regulatory effect on managed care organizations?

  1. How would this case study have differed if the patient was using public or social insurance?
  2. The response to each question should be a minimum of 200 words. Formal essay structure is not required; differentiated responses to each question are acceptable. 
  3. Integrate two to four scholarly sources in the collective assignment.
  4. Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. 
  5. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

Essentials of Health Economics

Dewar, D. M. (2017). Essentials of health economics (2nd ed.). Burlington, MA: Jones and Bartlett Learning. ISBN-13: 9781284054620

Government and Policy for U.S. Health Leaders

Higbea, R., & Cline, G. (2021). Government and policy for U.S. health leaders (2nd ed.). Burlington, MA: Jones and Bartlett Learning. ISBN-13: 9781284207767 (Available as a custom eBook - includes only Chapter 6)

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Explanation & Answer

View attached explanation and answer. Let me know if you have any questions.

Running Head: INSURANCE CASE STUDY ANALYSIS

INSURANCE CASE STUDY ANALYSIS
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INSURANCE CASE STUDY ANALYSIS

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1. Describe the payer systems mentioned in the case study
Integrated delivery systems (IDS) are collaborative, organized, and coordinated systems that
link different healthcare providers through various domains. The aim is the provision of a
synchronized and vertical continuity of healthcare to a specific community or group of patients.
The system is financially and clinically accountable for the population’s health status and
possesses strategies that are implemented to improve and manage them. There are two types of
integrated delivery systems, including vertical and horizontal (Al-Saddique, 2018). Vertical
integration involves the synchronization of services among departments operating in distinct
stages of the delivery of patient care. On the other hand, horizontal integration consists of the
coordination of activities among departments in the same stage in service delivery. Integrated
delivery systems are essential in the healthcare sector because they increase collaboration. The
implementation of such systems requires teamwork.
The teamwork will, therefore, assure continuity of care and the reduction of unnecessary
duplicated processes. The efforts of the members involved in the system are integrated towards
the development of continuous and effective care. This, therefore, leads to patient safety and
satisfaction. Integrated delivery systems also result in improved care management. The reason is
that the system provides the opportunity for patients to see many doctors who are conduct
diagnostic and work procedures more effectively. Care management forms the basis of
accomplishing coordination of care across healthcare settings (Al-Saddique, 2018). Its objective
is achieving the best cost and clinical outco...


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