Case One:
As the new benefits manager at Riley Industries, you have decided to implement a high deductible health plan (HDHP) for the employees. You have heard that HDHPS has many benefits, such as substantial cost savings resulting from employees taking charge of their health. You have also heard there are disadvantages. How should you educate the employees of Riley Industries on HDHPS? What if the employees want to keep their previous insurance plans instead? Discuss the other advantages of HDHPS to both the employer and the employees, including how employees are able to promote better health through these plans. Name some other disadvantages of the plans, including the inability to save for possible deductibles costs. What is your opinion on companies moving toward HDHPS?
Case Two:
You are the CEO of kind heart hospital, which is located in a low-income area and has spent millions of dollars over the years on charity care patients. Unfortunately, this has placed your hospital in a tough financial position, because Medicare and Medicaid continue to reduce reimbursements for their patients and your percentage of commercial insurance patients (or patients who pay more than your cost) continues to decline. Discuss what you can do to continue to provide care to the needy but reduce the amount of the loss. Will national reform laws help your reimbursement or hurt it?
Expert Solution Preview
Introduction:
As a medical professor in charge of designing and evaluating assignments for medical college students, I would like to address the following cases on healthcare management.
Answer for Case One:
Implementing a high deductible health plan (HDHP) for the employees of Riley Industries could lead to substantial cost savings for both the employer and employees. However, educating the employees about HDHPS is crucial. The employer could conduct training sessions and provide written resources on the benefits and drawbacks of HDHPS. The employer could also communicate the other advantages of HDHPS, such as lower premiums, tax-saving opportunities, and increased control over healthcare decisions. However, employees may want to opt-out of HDHPS and maintain their previous insurance plans. In such instances, the employer could explore alternate ways of incentivizing employees to join the HDHP, such as providing financial incentives or preferred health benefits.
Despite the advantages of HDHPS, there are certain disadvantages, such as the inability to save for possible deductibles costs and low-income employees struggling to meet the high deductible costs. Therefore, before implementing HDHPS, the employer needs to assess the financial and health risks of the employees.
In my opinion, companies moving towards HDHPS could be beneficial if implemented thoughtfully and carefully, keeping in mind the needs of the employees and financial stability of the company.
Answer for Case Two:
As the CEO of Kind Heart Hospital, providing quality healthcare to the needy should be the top priority, but reducing the amount of loss incurred is equally important. One approach could be to provide community-based healthcare and preventive services to reduce the demand for acute care, which could be expensive. Collaborating with community organizations and government agencies could be beneficial, such as offering free screening camps or vaccination drives.
National reform laws, such as the Affordable Care Act (ACA) and Medicaid, have expanded coverage for low-income individuals, but reduced reimbursements for hospitals that provide charity care. Therefore, the hospital may need to assess the financial impact of national reform laws on their operations and formulate strategies to manage the losses.
In my opinion, a balance of providing quality care to needy patients while managing financial sustainability is crucial. Therefore, exploring alternate fundraising opportunities and optimizing operational efficiencies could help mitigate the financial burden.
