The nursing industry
Healing Hands Hospital is an acute care health care institution located in a suburb of a metropolitan city. An important trend in health care that could significantly impact the hospital is accountable care and integrated delivery model. This essay identifies two types of managed care plans and their impact on the hospital, discusses the future of managed care as a viable reimbursement model, and how different legislation and laws could impact Healing Hands Hospital and its financial plans.
Types of managed care plans
There are different types of managed care plans that could impact the delivery of health care at Healing Hands Hospital. One such type is the Health Maintenance Organization (HMO) that involves the delivery of care to a group of patients through a prepaid system on a fixed fee. The beneficiaries of the plan must use doctors and physicians within the HMO network, and the beneficiaries can also choose a primary physician from a list of physician. A full service HMO provides both physical and mental health care services (American Academy of Paediatrics 2013). To benefit from this managed care plan, Healing Hands Hospital will need to join a full service HMO network. In addition, the hospital will need to work out with other providers in the HMO about the monthly premiums and co-pays for each hospital visit. Further, the hospital will need to work out how and when patients can be referred to specialists within and outside the HMO network.
Another type of managed care is the preferred provider organization (PPO), whereby hospitals, doctors and other providers become part of a PPO network that is served by a common insurance provider at a lower fee. Beneficiaries of the plan can choose a hospital or provider to go to and makes an annual deductible as well as a co-payment for every visit to a provider. This managed care plan could impact the way that health care is delivered at Healing Hands Hospital in different ways (American Academy of Paediatrics, 2013). For instance, the hospital might need to look for a suitable PPO in terms of discounts to offer the plan. In addition, the hospital should be prepared to receive more patients as the managed care plan offers attractive discounts for subscribers who use providers within the plan. On the other hand, the hospital should prepare to receive less reimbursement for each plan subscriber because of the discount.
The future of managed care plans
Managed-care plans involve contracts between health care providers and insurance providers, that restrict beneficiaries to a list of providers but will cost the beneficiaries less than when they are outside the plan. In contrast, the Accountable Care Organization (ACO) model involves a network of providers and hospitals that come together to coordinate the care of a given population with the aim of providing care at an improved efficiency. Value based reimbursement is based on rewarding providers for their efficiency and effectiveness of delivering care. While the ACO model and value based reimbursement allow patients to move freely within and outside the network, managed care plans restrict beneficiaries within the network. This guarantees patients more freedom when it comes to choosing a care provider when they are dissatisfied with a provider within a network. With more patients looking for more choice and freedom, the ACO model and value based reimbursement are more likely to receive more subscribers than managed care models.
Another difference between managed care plans and the ACO model and value based reimbursement is that the ACO model is driven by health care providers and not insurance companies (Freeman, 2013). For managed care plans, insurance companies tend to dictate the payment plan and what providers and patients can and cannot do. In the future, this could limit Healing Hands Hospital in terms of the care services to offer, how to offer them and what to charge for the services. Another point is that compared to managed care plans, the ACO model and value based reimbursement have more financial incentives when it comes to improving the quality of service delivery and sharing financial risks. This is because managed care plans involve paying providers a fixed amount for each patient, while the ACO model and value based reimbursement involves a variety of payment structures.
Impacts of health care laws
The different health care laws could impact Healing Hands Hospital and its financial plans in different ways. First, the laws have increased the number of people with insurance plans making it more possible for patients to pay for care. This implies that hospitals are receiving more funds through patient payments hence more profitability and better financial position. The second impact of these laws is that they have made it a requirement for hospital to be more efficient and effective in delivering care (LaPointe, 2016). Hospitals such as Healing Hands would need to control their costs by eliminating unnecessary costs in order to achieve the efficiency needed to fully benefit from reimbursements and financial rewards. Another impact of these laws is that providers like Healing Hands Hospital could face lower reimbursement rates if they fail to attain efficiency
In conclusion, Health Maintenance Organization (HMO) and preferred provider organization (PPO) are two managed care plans that the hospital could join. The future of managed care plans is not so bright because of the beneficiary restriction and insurance company control. Lastly, Healing Hands Hospital could be positively and negatively impacted by health care laws.