MARKET RESEARCH AND SEGMENTATION (SLP)

HMO

An HMO requires someone to select primary care physician who acts like gatekeeper and coordinates care meaning the doctor must refer the patient first in order to be attended by the specialist. The HMO are normally lower compared to other plans because it does not have deductibles. A client pays for test, office visits and prescriptions. Seemingly, this plan is needed when one does not have to see many specialists and they do not need referrals often. Second, it is used when one has primary care physician and when a client if comfortable with providers in the network (Rowe, Brown-Stevenson, Downey, & Newhouse, 2008). Most important in HMO, cost is important than the flexibility, the drawback is HMO does not allow someone to go outside the network for care.

PPO

This insurance health plan have preferred network of care givers in patient area and one does not have to choice a primary care doctor or referral in order to see specialist. If a client use preferred provider, he or she is responsible for paying part of the bill. The main benefit of PPO is flexibility; however, this comes at a higher cost and deductibles. PPO is right when a patient wants flexibility and does not need referrals and when flexibility is more useful than paying higher premiums.

POS

This is a hybrid of PPO and HMO plan. Like in the case of HMO, a patient need a recommendation from PCP for him or her to be attended by expert. But like PPO, the client pay less for him or her use doctors and hospital providers in the plan network. In POS there is room to access out-of-network providers at a higher cost (Wagner & Kongstvedt, 2007).

MCO

Managed Care Organization is a Family Care Program which coordinates service from various programs and combine then into single long-terms plan of service according to personal preferences and needs of the team members.

ACO

Accountable Care Organizations are group of surgeons, physician and specialists who manage care for patient with the intention to improve condition of care at the same time as reducing spending. ACOs associate imbursement for the service to quality of healthcare provided and efficient clinical attention. ACO clients can move within and outside integrated network. Participants can choose PCP, hospital of choice and even the specialist.

Difference between ACO AND HMO

HMO is a controlled healthcare and patients choose doctors and hospitals for a minimum period of time. In HMO, if patients are unhappy, their options are limited to doctors under HMO network. HMO patients stay in network and doctors are no meaning exit of doctors attending patients can disrupt care. ACO has no enrollment lock-in provisions so patient can seek care freely. ACO are not insurance firms, they are provider-led companies.

Difference between HMO, PPO, POS and ACO?

Choosing the right insurance plan depend on personal decision and the situation and preferences. The issue to take into account include flexibility, cost, coverage and convenience. If a client needs a large groups of car e provider and does not mind paying extra for the care, the PPO is the best option.

Features of a Consumer-Driven Health Care Plan (CDHP)

CDHPs are set of plans which put power and responsibility into the hand of the clients. Typically, CDHPs involve a high deductible health plan commonly referred to as HDHP with a saving account.

Advantages

CDHP have a lower premium because they are responsible for much of their costs on health care. Client has the same freedom of choice which is similar to PPO plan in that the patient does not have to choose primary care physician and get referrals. Also, it save cost as result of taxes and it has more responsibility over personal health cost.

For a health person, who does not frequent the doctor, one can save a lot of funds and if something happens, he or she is covered. However, if someone needs office visits and prescriptions, one can end up paying more. This means that one should weigh different scenarios and check if CHDP is worth it.

In CDHP a client pays more out-of-pocket before the medical plan begins. For this reason, people who choose CDHP tend to be more informed about their health, are healthier and more cost-conscious. A person who use CDHP pay for service through pre-tax savings referred to HSA. The HAS is funded by employer or employee or both.

The key feature of CDHP are

1. Round the clock accessibility

2. clinical assessment

3. It has consistency, health education, accurate triage information, and safe-care options

4. Coordination with patient primary care physicians.

Monthly payments, lower premiums are other advantages of CDHP compared to the traditional benefit plans. It is argued that people using the CDHP spend about $500 less annually on health care compared to those using the traditional plan. In the Consumer-Driven model, clients assume the main role of decision-making concerning the healthcare they receive (Goodman, 2005)

References Goodman, J. C. (2005). Consumer Driven Health Care. Networks Financial Institute Policy Brief, Indiana State University. doi:10.2139/ssrn.985572 Rowe, J., Brown-Stevenson, T., Downey, R., & Newhouse, J. (2008). The effect of consumer-directed health plans on the use of preventive and chronic illness services. Health Affairs, 27(1), 113–20. doi:10.1377/hlthaff.27.1.113 Wagner, E. R., & Kongstvedt, P. R. (2007). TYPES OF MANAGED CARE ORGANIZATIONS AND INTEGRATED HEALTH CARE DELIVERY SYSTEMS. 19-25.