Financial Status of Seamus Company

Financial Status of Healthcare Organization
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Financial Status of Healthcare Organization
A1. Propose three fiscally sustainable strategies for Seamus Company from the perspective of a CFO, moving away from a fee-for-service model to an MCO model.
Strategy 1
The CFO should adopt the PPO medical insurance plan. PPOs are a popular choice for people looking for health insurance. Doctors and hospitals in the PPO only treat members of a specific company or group of employees. The company can implement this type of insurance as an organization as it is legible for the plan. The doctors in the network will offer discounted prices to all employees in the company, regardless of whether or not they are policyholders or sponsors.
In contrast to other types of insurance, in this one, the employees would not need a recommendation from a primary care physician to see a specialist under this plan. Employees will always select a doctor who is not part of the accredited providers, even though doing so will likely result in a significantly higher bill for their medical care. However, selecting a doctor from the approved list of providers' networks typically has the benefit of a significantly lower price.
Strategy 2
The CFO can implement an HMO medical insurance plan. A health maintenance organization, also known as an HMO, is an organization that offers a way to take care of the health care requirements of an entire workforce or membership at a reduced cost by negotiating with particular medical professionals, hospitals, and clinics. To take advantage of the more affordable premiums offered by the medical insurance plan, the employees of the Seamus Company will use the services offered by the specified providers. If the employees have an HMO plan, they will have the least amount of flexibility, but they will also likely have the smoothest time dealing with claims because the network will take care of putting in the claims for them. The company will be required to pay a set monthly fee regardless of how much care the individual receives because the service is usually pre-paid. Medical visits, hospitalizations, and surgeries are all covered under their health insurance plan.
Strategy 3
The CFO can also affect the POS medical plan. This type of plan combines elements of both the HMO and PPO types of insurance. Employees need to be referred by their primary care physician to see a specialist. Members who opt to receive care from outside providers will be responsible for paying a higher deductible and a more expensive copayment. The POS system enables more significant levels of customization. If one sees more than one doctor or specialist, they can come from inside or outside the network. However, the primary care physician does not need to permit one to make this decision. On an annual basis, out-of-pocket payments will be typically kept to a minimum by the company.
A1a Recommend a plan to carry out each of the three sustainable strategies from part A1 by including cost-saving measures, tax-deductible considerations, and other tax advantage fiscal management improvements.
PPO
PPO may not save as much as some, but they may help a CFO save on ...