Comparative Analysis of Different Healthcare Plans (Essay Sample)
There are various types of plans consumers can select. MCOs, HMOs, PPOs, POSs, or ACOs are the most common ones; however they all supply various benefits and drawbacks. Consumers (patients) have the right to choose the type of plan that best fits their needs. In fact, health care is a consumer-driven industry and as health care costs have continued to increase, consumer-driven health plans (CDHP) have become the next new thing (after managed care) (Fronstin & MacDonald, 2008). As a health care leader, it is vital that you understand the differences in these plans.
Fronstin, P., & MacDonald, J. (2008). Consumer-driven health plans: Are they working?
For the Module 2 Case Assignment, conduct additional research as needed and prepare a 3- to 4-page comparative essay. Your comparative analysis should include a detailed comparative chart. In your comparative analysis and chart, you are to evaluate and discuss:
- The key features, differences, and disadvantages between MCOs, HMOs, PPOs, POSs, and ACOs.
- The key features of a Consumer-Driven Health Care Plan (CDHP).
- The future of CDHPs, MCOs, HMOs, PPOs, POSs, and ACOs.
You are to support your analysis and views with at least four scholarly references (i.e., peer-reviewed journal).
- Conduct additional research to gather sufficient information to justify/support your proposal.
- Limit your response to a maximum of 4 pages.
- Support your proposal with at least 4 peer-reviewed articles.
Comparative Analysis of Different Healthcare Plans
Comparative Analysis of Different Healthcare Plans
The high cost of healthcare in the United States has in the recent past created the need for patient-friendly plans. Thus, a number of health care plans have been developed, with each focusing on consumers’ specific needs. These plans include managed care organizations (MCOs), health maintenance organizations (HMOs), preferred provider organization (PPOs), point of service (POS), accountable care organizations (ACOs), and Consumer-Driven Healthcare Plan (CDHP). Even though all these plans were implemented to address the rising cost of healthcare and to address consumer-specific needs, they all have different features and disadvantages.
On one hand, MCOs are a group of health care providers and facilities that provide healthcare services to patients at a reduced cost (MedlinePlus, 2019). Thus, the main focus of MCOs is utilization management through efficient use of healthcare resources with the intention of reducing healthcare costs. The key feature of MCOs is that first, they restrict patients’ choice of providers (MedlinePlus, 2019). Thus, patients must have a primary care provider and the flexibility of the plan is limited. Second, information is only shared if requested because providers under the MCOs do not collaborate like ACOs. Thus, the key disadvantage is that MCOs are not able to act fast because of lack of an effective health record sharing infrastructure. MCOs come in three different types of care plans. The first one is the HMO, which requires the selection of a primary care provider within the network (MedlinePlus, 2019). The key features of this plan include a mandatory primary care provider referral and restricted within-the-network services. Thus, any care acquired out of the network is usually not paid for. The second type of care plan under MCOs is the PPO. PPOs are less restrictive than HMOs in the sense that any out-of-network services will be paid for, at least partially (MedlinePlus, 2019). However, patients are still expected to choose a network of preferred providers. They are also more costly than HMOs since they are less restrictive. The final type is the POS, which according to MedlinePlus (2019) allows a patient to choose between HMOs and PPOs. Thus, the patient can either chose a more restrictive, less costly plan or vice versa, under the POS.
On the other hand, ACOs are a network of healthcare providers that improves population’s health by providing incentives to coordinate care amongst all providers and remove unnecessary spending (Chukmaitov et al., 2015). Thus, the main focus of ACOs is quality of care improvement through care coordination. Some of the key features of ACOs include voluntary participa
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