Tag: provider

Topic: The Strengths and Weaknesses of Multi-Site Provider Organizations

Early on the concept of an HMO was of multi-site staff or group model practices with some integrated facilities and integrated financing.  Some h ave reported advantages of multi-site operations which could be achieved by an HMO.  They include:

Exploiting intellectual capital by replicating successful models and methods
Improved access to capital markets
Exploitation of increased purchasing power
Economies of scale in back room operations
Diversification of local market risks
Branding and marketing to regional and national accounts
Ability to conduct and amortize research, such as access to large data bases for analysis and implementation of the findings over a larger population.
Look at an “HMO” in your area and assess the extent to which it has been able to achieve these advantages. The choices range from a Blue Cross-type organization to a Kaiser-type to a for-profit such as one of new Medicare HMOs subsidized by the federal government.

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Healthcare Policy

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            Since 1970s, beneficiaries of Medicare have had the alternative to get their benefits in Medicare via individual health plans, for example Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs), as alternatives to the nationally administered conventional Medicare Scheme. Apparently called Medicare Advantage plans, their individual health covers get capitated costs to give to enrollees of the plan services covered by Medicare. This paper will give reasons why HMO has been successful in my region in achieving certain advantages such as enhanced contact to capital markets, marketing and branding to national and regional accounts among others.

            Consumers in this region started to accept HMOs not just because they charged reduced premiums but because they provided benefits that were extensive such as cover of preventive amenities, women’s and children’s preventive healthcare visits, as well as drugs prescription. The conventional insurance of Blue Cross and Blue Shield (BCBS) plans did not provide these services at the time. However, with changes in health sector, BCBS plans merged and started giving enrollees a wide selection of physicians and hospitals compared to members in cluster health clinics. Both plans include all services of hospitals apart from items of convenience within certain contracts (Fox & Kongstvedt, 2013). This enables the HMOs to maximize its increased purchasing power.             At each level, the state triggered the growth of managed care in added ways. For example, the biggest employer agreement with HMOs on a two way basis was amid U.S Office of Personnel Management (OPM) plus the Kaiser Foundation Health Plans. This method was taken by several big employers. This method of Medicare pays phy………………………………………………………………………………………………

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