Health Care Financing

You have been asked by a health care magazine to write a series of articles focusing on health care financial concepts. The articles will be included in five consecutive issues and will be geared towards readers with little knowledge of finance. You must ensure that the articles are both informative and engaging to your audience. You must also ensure that your articles relate financial principles to the health care industry.

One of the major functions of a nurse manager is managing a budget and allocating resources necessary to manage the unit or facility effectively. “Major steps in the budgeting process include gathering information and planning, developing unit budgets, developing cash budgets, negotiating and revising, and using feedback to control budget results and improve future plans”(Yoder-Wise, 2012, p. 244). The nurse manager must be able to accommodate variances and acclimate the budget in both the projections and up-to-date expenditures. Proficiency in managing a unit level budget is essential for both a favorable variance and optimal patient outcomes. Budgeting entails reviewing revenues and expenses, staffing costs, supplies, and capital equipment costs (Contino, 2001). This case study examines personnel, overtime (OT), supplies, travel, equipment, and staff education and the manner in which management can address these factors.

As a managed care organization Kaiser Permanente has served as a model for informational healthcare systems and the recent demand for affordable care has prompted the organization to lower cost in services without hindering the quality of care. Kaiser Permanente has integrated a system in which the organization assumes all financial risk and a bundled enrollment fee for service strategy. What makes Kaiser Permanente unique from other HMOs is their accountability for quality, utilization management, financial risk, and business strategies (Kaiser Permanente, 2009).

While our understanding has evolved with respect to certain advantages of MCO’s, our understanding of the disadvantages has also grown. This analysis will evaluate the use of MCO’s as a gatekeeper to controlling health care cost and offerings. It will evaluate the advantage MCO’s provide in a rapidly growing market due to the aging of baby boomers. The analysis will evaluate disadvantages that can arise with relying on MCO’s. These disadvantages work against the insurance company forcing a polarizing balance between how much control the MCO should retain over recommendation and provision of services.

Many people are concerned about rising health care costs. In reaction to this, some individuals and companies are gravitating toward the assumed lower prices of Health Maintenance Organization (HMO) health plans. HMOs spend billions of dollars each year advertising their low cost services. While these savings look good on paper, there are many pages of small print. The explanation after the asterisk indicates that not only do the HMOs lack lower costs, but they also short-change the patient in quality care. Much of the money spent on premiums goes directly into the pockets of stockholders and less is then available for

Castor standard and Castro Enhanced are individual plans, Castro standard does not cover preexisting medical conditions. Castro Enhance does cover preexisting medical conditions. Castro Collins must now look at the risk, cost and profitability the company will incur in providing insurance to both groups. Castro Collins also provides detail of service for both groups. Coverage for the following services is provided under the terms and conditions and at the co-payment each company list for chemical dependency, treatment, durable medical equipment, emergency services, family planning, hospitalization services, maternity care, and mental health care services,

Essential healthcare management includes the financial growth and feasibility of the health care organization. In order for a healthcare organization to reach its full potential it needs to be fully staffed with both medical and managerial professionals, as well as having the funds to invest in the most up to date technology. According to the Kaiser Family Foundation “Baseline estimates show that over 41 million individuals were uninsured in 2013, 61% of uninsured adults said the main reason they were uninsured was because the cost was too high or because they had lost their job”. The EMTALA or Emergency Medical Treatment And Labor Act or anti-dumping law was enacted in 1986 it was designed to prevent hospitals from transferring the uninsured or Medicaid patients to public hospitals without providing a medical screening examination to ensure they were stable for transfer first. Regardless of their options to pay, they are to be seen and treated with life-saving and "stabilizing" emergency care with transfers to advanced trauma centers, if need be. Effective Human Resources coupled with a balance between cost and revenue are essential to being able to provide quality Health Care. It has been proven these elements all play positive roles in contributing to the overall efficiency of the system. An organization can enhance the quality of health care provided just by focusing on the major components.

I have been asked by Cooper-Pearson to research different medical insurance plans that they could consider as one of their selected insurance programs for their marketing company. My goal is to provide them with enough details in order for the company to make an informed decision as to which program they would like to consider. This information will allow them to provide their employees with an effective compensation package that is both affordable and desirable and I believe that once an attractive compensation plan is in place; we should expect the retention rate of the company to improve and the recruitment of quality employees to increase as well. First I will start by demonstrating the comparison and contrast between an HMO plan and a

Today, health care issues within the United States are still a major concern in regards to where people of our communities do not always agree with what is being done and what is not being done. The three major issues with health care spending is how much is it going to cost and where is the money going to come from? The amount of per-patient costs have doubled more in the United States than other nations around us. The last issue is the amount of Americans that has no health care at all. This paper will discuss the healthcare expenditures that is necessary for our entire population.

Castor Collins Health Plans is a regional HMO founded in 1999 in the state of Pantome (University of Phoenix, 2011). Using a capitation model to pay its network of health providers, the HMO provides health insurance and health care services to enrollees statewide (University of Phoenix, 2011). Castor Collins currently has 100,000 enrollees throughout Pantome and is actively pursuing to companies to increase this number. The fact that Castor is currently in expansion mode may give the companies an advantage in terms of bargaining for rates. Because Castor is a small company trying to become a big one, acquiring new clients is very important to the company.

“Reimbursement” in healthcare refers to the decision of the entity paying for an item or service (called the “payor”) of whether a particular item or service is covered by a particular healthcare payment program for the patient at issue and therefore eligible for payment. “Payors” refers to the entity through which an individual has healthcare coverage. The federal government is the largest single payor of healthcare services in the United States through a variety of federal healthcare programs such as the Medicare and Medicaid programs established under the Social Security Act (SSA).

The three principle parties involved in the U.S. Healthcare system are the consumer, provider and insurer. The provider includes the hospitals, clinics, doctors, nurses and pharmacies that provides a service; the consumer is the individual who receives the medical service and supplies the money; and the insurer is a third party intermediary between the provider and the consumer which accept money from a pool of consumers and reimburse the providers. Like any transaction, there is a certain degree of risk associated for members of the different parties. This risk is based upon variables within the U.S. healthcare model including the method of, and who is reimbursing the providers.

Surprisingly, U.S. managed care has been in existence for almost a century. In 1910, the Western Clinic of Tacoma, Washington offered medical services through its network of doctors and nurses for the premium payment of $0.50 per member per month. Nearly one hundred years later, managed care organizations (MCOs) have changed dramatically with increased complexity and significance to the U.S. healthcare market. Aggregate revenues for MCOs in the S&P 500 index grew 30% in 2006 to $212.4 billion while earnings per share estimates are expected to increase by 15% for 2007. The purpose of this paper is to analyze the United States’ managed care industry in understanding the sources of profitability.

Fee-for service arrangements prevailed as the preferred vehicle for financing health care services since World War II. As employers began to offer health insurance, premiums were fixed in such a way that most patients did not bear the full cost of their health care. As employer premiums rose to meet the escalating cost of health care services, efforts by government, business and the insurance industry focused on controlling utilization and reducing health care cost (Cox, 2001). Group health cooperatives were formed as early precursors of the modern health maintenance organization. As managed health care became more widespread, methods of cost containment became more prevalent by defining medical necessity, coverage policies, practice guidelines,

Government financed health care typically has more control to place limitations on care offered to patients and doctors in order to keep costs down. Since payers must try to deliver the most care for the