Managed Care and Accountable Care Organizations
*Discussion
Managed Care and Accountable Care Organizations (ACOs)
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Please share your experience on selecting a managed care plan. Please discuss the advantages and disadvantages of your MCO plan.
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Many argue that there is no consistent, direct correlation between the cost of care and its quality in a managed care program. Do you agree or disagree?
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Do you think patient’s choice of provider and access to care will be limited under ACOs?
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In what ways can an ACO succeed in both delivering high-quality care and spending health care dollars more wisely?
****CASE
Module 2 – Case
MANAGED CARE AND ACCOUNTABLE CARE ORGANIZATIONS
Assignment Overview
Please view these short clips before beginning your assignment:
Consumer Driven Health Care
https://www.youtube.com/watch?v=7M9vNhbFlD4
What Is the Difference Between HMO and PPO?
https://www.youtube.com/watch?v=vKMN6SRyBEA
Advantages & Disadvantages of HMO Insurance: Health Insurance More https://www.youtube.com/watch?v=ZUbKl_9jwDk
PPO vs HMO Understanding Health Insurance Series https://www.youtube.com/watch?v=Vma6RJXfb-w
Case Assignment
For the Module 2 Case Assignment, conduct additional research as needed and prepare a 4- to 6-page paper to address the following questions:
- Discuss three major criticisms/drawbacks of managed care.
- Explain the major features of a consumer-driven health care plan (CDHP).
- Compare the difference between a managed care plan (HMO or PPO) and a CDHP plan in terms of choice of providers, covered benefit, and level of cost sharing.
- What feature(s) enable ACOs to control cost and improve quality of care?
Assignment Expectations
Please submit a 4- to 6-page paper which does not include the cover page or reference page.
***SLP
Module 2 – SLP
MANAGED CARE AND ACCOUNTABLE CARE ORGANIZATIONS
SLP Assignment Expectations
Watch this short video:
Accountable Care Organization (ACO) Trends in Healthcare https://www.youtube.com/watch?v=P1E_nS6TkNM
- For the Module 2 SLP please submit a 4- to 5-page paper that lists all types of managed care plans/products offered by your employer and compare the features (e.g., employee cost sharing, premium contribution, covered benefit, freedom of provider choice, and so on) between these offered MCO plans. If your employer also offers a CDHP plan, include it in your discussion.
- Conduct some preliminary research on the initiatives and formation of one ACO in your state or any state of your choice.
- How is this ACO organized (it can be one of the five models listed on the Module Home page)?
- How do payers pay this ACO?
- How are payments distributed among the providers within this ACO?
- What are the quality measures used to evaluate the performance of this ACO? And what are the rewards and penalties for performance quality?
You can start your research by visiting the Integrated Healthcare Association website: http://www.iha.org/
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