Financial Resource Management in Healthcare – C428 Final Paper

Financial Resource Management in Healthcare – C428 Final PaperA1. Fiscally Sustainable Strategies A financially sustainable strategy that can be discussed is switching from a fee-for-service plan to a managed care plan. There are three different types of managed care organizations: • Health Maintenance Organizations (HMOs) • Preferred Provider Organizations (PPOs) • Point-of-Service Plans (POS) HMOs are the most common type of managed care organizations. HMO’s are business engagements between physicians, insurers, and hospitals. HMOs usually have little to no deductible and low-cost premiums, however HMOs are restrictive in when and whom the patient can see for care. HMO’s require patients to pick a primary care provider (PCP) in- network and see that provider for all their care. If a patient wants to see a specialist, they need to first get a referral from their PCP. HMOs keep costs low by restricting whom the patients can see as all services are kept within the network and out-of-network visits are usually denied passing the whole cost onto the patient, except for emergency care. Preferred Provider Organizations are another common managed care organization that is growing in popularity. Healthcare insurers contract with a large network of providers and hospitals to create the preferred provider network. With PPO insurance, you’ll have access to more doctors, specialists, clinics, hospitals, and other healthcare facilities. You will not be required to select a primary care physician, although it is highly recommended that you do, and you do not need physician generated referrals to see a specialist. To provide such flexibility and the greater pool of providers and facilities, a PPO with generally have much higher premiums