You have been presented an
outstanding opportunity to serve as a graduate student intern for the chief
executive officer (CEO) of a large HCO. The HCO is an HMO model and originated
approximately a century ago as a small rural hospital. Due to the rural setting,
the HMO model flourished and, over the years, expanded throughout the region.
Today, the HMO has a presence in over eighteen counties and has a number of
competing interests from for-profit and not-for-profit HCOs in the region.
The board of directors recently
approved the acquisition of two regional hospitals. First, the HCO decided to
acquire a small rural critical-care-access hospital in a relatively remote
county. The interest in acquiring the hospital is to service the existing
population and expand the reach of the HMO. Second, the HCO decided to acquire
a private full-service hospital in a moderate-size city (population forty-two
thousand). The HCO’s move is strategic in nature, preventing the sale of the
hospital to its for-profit competitor, and will gain the region its sole
emergency department level 2 (two) trauma center with helicopter transport
while giving the HCO the ability to service its growing HMO membership in the
area.
Based on the above information:
- Evaluate the various HMO models (staff, group, and
network) and identify the model that would probably be best suited for the
region. Justify your answer. - Research and comment on the importance and
applicability of the various levels of emergency department trauma care.
Investigate the exemptions afforded to a critical care rural hospital with
respect to Medicare reimbursement and accreditation. - Elaborate on the difference between an HMO and an
accountable care organization (ACO). - Explain the concept of capitation, its importance to
the HMO and participating providers, and how the concept of capitation
varies with the ACO model. - Explain patient-centered care and its importance in
healthcare delivery.
Submission Details:
- Submit your answers in a 2- to 3-page Microsoft Word
document. - Use scholarly resources within last 36 months.
- Cite all sources using APA format with in text
citations on a separate page.
Assignment 3 Grading Criteria | Maximum |
Commented on the importance and | 10 |
Identified the HMO model that | 5 |
Outlined the exemptions afforded | 10 |
Identified the difference between | 10 |
Explained the concept of | 5 |
Presented a structured document | 5 |
Properly cited sources using APA | 5 |
Total: | 50 |
Expert Solution Preview
Introduction: This assignment presents a scenario of a large HCO that has decided to acquire two hospitals. The purpose of this assignment is to evaluate the various HMO models, comment on the importance and applicability of levels of emergency department trauma care, outline the exemptions afforded to a critical care rural hospital, identify the difference between an HMO and an ACO, explain the concept of capitation and patient-centered care.
1. Evaluating the various HMO Models
In the given scenario, the HCO is an HMO model that originated as a small rural hospital. The HMO model is best suited for the given region as it has a presence in over eighteen counties, and this model is designed to service populations in a particular region. HMO uses a staff model which provides healthcare services to the members through the healthcare providers employed by the HMO. This model has proved to be more effective in providing healthcare services to the members as the healthcare providers work in cooperation with each other and the HMO to provide the best possible care for the members.
2. Importance and Applicability of the Various Levels of Emergency Department Trauma Care
The different levels of emergency department trauma care are based on the types of services and resources available at the given trauma care center. A Level 1 trauma center provides the most comprehensive trauma care, including research and education, while a Level 4 trauma center provides the least comprehensive trauma care. It is important to have different levels of trauma centers to ensure that patients receive the appropriate level of care. Rural critical care hospitals may have certain exemptions to Medicare reimbursement and accreditation due to the unique challenges they face in providing care to their populations.
3. Difference Between an HMO and an Accountable Care Organization (ACO)
An HMO is a health plan that provides health services to its members for a fixed monthly premium. The HMO networks with healthcare providers to offer services to its members. On the other hand, an ACO is a group of healthcare providers that work together to coordinate care for a specific group of patients. An ACO is based on a fee-for-service model where providers are rewarded for providing quality care at lower costs.
4. Concept of Capitation
Capitation is a method of payment in which healthcare providers receive a fixed payment per member per month, regardless of the number of services provided. The concept of capitation is important to the HMO and participating providers as it places an emphasis on prevention and keeping patients healthy. The ACO model differs from HMO in that providers are not paid a fixed payment per member per month. Instead, providers are rewarded for providing quality care and reducing healthcare costs.
5. Patient-Centered Care
Patient-centered care is an approach to healthcare delivery that places the patient at the center of care and focuses on the patient’s needs and preferences. Patient-centered care emphasizes on communication, respecting the patient’s values and preferences, and involving the patients in their care decisions. Patient-centered care is important in healthcare delivery as it improves patient satisfaction, patient outcomes, and reduces healthcare costs.
Conclusion: This assignment evaluated various aspects of healthcare delivery, including the different HMO models, levels of emergency department trauma care, the difference between HMO and ACO models, concept of capitation, and patient-centered care. Understanding these aspects of healthcare delivery is essential for future healthcare providers to excel in their careers, making the healthcare system stronger and more effective.
