HSA3109 2022 December Discussions Latest (Full)

HSA3109 Foundations of Managed Care

Module 1 Discussion

Healthcare Choices

Today’s healthcare consumer has more insurance coverage options available than ever before. Managed care organizations have made it so that individuals, on their own (through Medicare or Medicaid) or through their employers, can select healthcare coverage plans that best align to their needs. Everyone’s family dynamic, income, and needs are different, and making choices regarding healthcare coverage allows people to make decisions based on those differences. Some people would prefer to pay more up front so that they don’t have to pay as much on the back end. Others think about addressing health conditions that may be existing. Health insurance is not a one-size-fits-all. What are some of the things that should be considered when making decisions about what health insurance is best for you? Explain.

 

HSA3109 Foundations of Managed Care

Module 2 Discussion

Continuity of Care

When we think about continuity of care, which involves multiple healthcare providers working together over time to best manage a patient’s health, we should think about the provider (physical therapist, physician) and the healthcare institution (hospital, ambulatory surgery center). The goal is to render the patient high quality, accessible, and cost-effective care. Explain a possible concern that a patient may have with a provider or facility responsible for their care and who, as part of a managed care plan, they would address those concerns with.

 

HSA3109 Foundations of Managed Care

Module 3 Discussion

Preventative Care

In recent years, there has been an increasing focus on preventative care from all levels—federal, local, state, private insurance, and managed care. By having patients receive regular checkups from their healthcare providers, the patients are more likely to remain healthy because their healthcare providers have more opportunities to detect, treat, and/or prevent potential healthcare concerns. From a managed care perspective, early detection and potential prevention is more cost-effective than if concerns went unnoticed and could potentially evolve into costly conditions.

For your initial discussion board posting, conduct research that helps you to explain how early detection and prevention of a specific illness or disease, such as diabetes, can help both the patient and the managed care organization. Think about what it would mean for someone to find out that they are pre-diabetic, as opposed to finding out later when the condition has had time to manifest. Discuss the impact it could have on both patient and managed care organizations if not detected early.

 

 

 

HSA3109 Foundations of Managed Care

Module 4 Discussion

Patient Outcomes

From the perspective of patients, it often seems as though they have been sent home early from being hospitalized even though they still feel ill. With changes in healthcare reimbursement models, this may be changing. Many insurance companies are now reimbursing healthcare providers based on patient outcomes.

Do hospitals benefit from discharging patients early before they are fully recovered? Can you share an example of when you or someone you know was treated or hospitalized by a healthcare provider but somehow felt the care you received was not adequate? How should reimbursement to healthcare providers work in those situations?

 

HSA3109 Foundations of Managed Care

Module 5 Discussion

Uninsured and Underinsured

Although there have been more individuals and families insured as a result of the implementation of the Affordable Care Act (ACA), there are still many that are uninsured and underinsured. Share your thoughts on the difference between being uninsured and underinsured, then describe one way that we can help bridge the disparity in healthcare?

 

HSA3109 Foundations of Managed Care

Module 6 Discussion

Healthcare Coverage Models

In a traditional fee-for-service model of healthcare coverage, healthcare providers are reimbursed based on each service rendered. In a fee-for-service model, patients are not restricted or limited to receiving care from a specific healthcare network and instead are free to move from provider to provider, as long as the provider accepts their health coverage plan. In a managed care model, providers are reimbursed based on an agreed upon amount (capitated) that is received periodically (usually monthly). In this model, patients are part of an affiliated network of providers and facilities that work together to address patient’s needs. Based on your readings and/or experience, which of these models do you think is best for patients and why? Share a brief example of a healthcare encounter, in either model, (patient financial responsibility and outcome) and how it supports your decision.

 

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