Discussion Reply- Response 1-2 paragraphs with 1-2 references

Brittnie Bennett

As a healthcare administrator, there are a few managed care plans to choose from for the organization. Keeping in mind both the patient satisfaction from the plan, but also thinking about how the provider and facility will be treated with the specific plan. The Health Maintenance Organization, or the HMO was first initiated to help control healthcare costs (Casto 2018). My recommendation would be that the organization adopt the HMO plan because I think that it represents both the patients and the providers well. Some HMOs hire the provider and own the hospitals, and others have contracts with the providers to provide services (Casto 2018). The negotiated payment rates in the contract with these providers are discounted, but the providers don't mind that knowing that there is a certainty of referrals and income (Casto 2018). Even though there are four basic HMO's, they all share certain characteristics. They are an organized system of healthcare delivery to a certain geographic area, and have voluntarily enrolled patients (Casto 2018). They also have established a set of basic health maintenance and treatment services and have multiple payment options for enrollees (Casto 2018). HMOs emphasize preventative care, they believe that in the long run, preventative care will cost them less then the care and treatment a patient would need for a chronic illness. I would definitely recommend my organization adopt HMO's and the beliefs behind the plan.

As the role of a healthcare administrator, it’s important to consider all options when thinking about managed care plans and whether or not those plans have better outcomes than the traditional fee-for-service plans. A vital goal is to provide access to care for all patients and ultimately improve our organization's quality of care. However, there are a few factors to consider when looking at managed care plans—for instance, economic incentives. Managed-care plans like HMO plans can have cost risk if services or payment exceed what the plan’s contract with the state consisted of. A positive that comes with capitation is that providers are encouraged to keep all patients who are enrolled healthy and updated with all tests and appointments to keep the cost low. As a healthcare administrator, I would recommend being for managed care plans because HMOs focus on providing the highest quality of care to patients. To accomplish the goal of delivering high-quality care to our patients, the four main principles from MCO should be the main focus.

The four main principles that perform quality improvements are selecting providers, the health of populations, the use of care management tools, and the maintenance of participation in quality improvement programs. The providers' selection should be based on the geographic area, the population, the services of which the provider is credited, and the provider’s online reviews. Health outcomes are also a priority when looking at managed care plans. Programs such as wellness management, preventive health, access to home health, and hospitals are a positive insight when looking at our members' health care services. Care management tools are also a positive component - care coordination, case studies, disease management are all tools that help with how accessible healthcare is to our population. Lastly, the quality assessments focus on all aspects of finding improvements. For example, Casta states that “as part of clinical improvements, surveys are taken to obtain feedback on issues such as the plan’s strengths and weaknesses, the needs of customers, and the satisfaction of clinical and administrative care” (2018). Surveys are an important element when looking at how to improve the quality of care. Surveys from patients, employees, physicians, and even disenrolled members help measure ways to control costs and find the best healthcare plans.