Blue Cross Blue Shield Case Study

The fertility rate is an important factor when evaluating the health of the public. Despite the United States having one of the best healthcare systems in the world, approximately 13% of women between the age of 18 & 44 have trouble conceiving. Although the US has implemented the Patient Protection and Affordable Care Act, a landmark policy, assisting millions of Americans in obtaining health insurance, unless altered, the policy could hurt the 3 out of 20 women who struggle with infertility. After evaluating the core essential benefits of the Affordable Care Act, the views of stakeholders, and the state mandates, an easy solution can be established to assist those suffering from impaired fecundity.

After a brief review of this discussion lecture. I learned the BlueCross and BlueShield also offer Medicare benefits. BlueShield plans only covers physician’s charges and BlueCross only covers hospital charges. Although Medicare benefits are offered from BlueCross and BlueShield its only offered to people that are 65 years and old and to those who are under 65 years of age but suffers from disabilities like renal disease that requires long term care such as dialysis or a kidney transplant.

Currently I work for Blue Cross Blue Shield of Tennessee which is one part of a complex health care system that has a lot of stakeholders. The four most visible stakeholders first would be patients, who seek medical services and advice (“The Modern Health Care Maze,” 2009).Second stakeholder would be providers of services and products, including hospitals, doctors, nurses and durable medical equipment. Third stakeholder would be payers such as private insurance companies, Medicaid and Medicare government programs and their employees. The fourth stakeholder would be employers, who purchase for their employees health insurance, then the federal government gives the employers a tax liability break allowing them to deduct this purchase on their

The A single-payer national health program (NHP) has similarity to the Affordable Healthcare Act. However, it better because is addresses some of the issues that were left out of the ACA. Like, free choice of providers and the preservation of doctor–patient relationships are threatened by our current system (Gaffney, Woolhandler, Angell, & Himmeslstein, 2016). With each enrollment cycle, patients seeking affordable premiums or changing jobs must often switch insurers and risk breaking existing relationships with providers.

The Affordable Care Act includes a requirement that all citizens must have some level of health coverage. The primary method through which the mandate is attempting to create 100% coverage in health care is by instilling fear into the minds of hardworking citizens as those who ignore the rule will have to pay a hefty fine. This mandate, unconstitutional according to the law, will deteriorate the quality of health care, hamper economic growth and cause spikes in insurance premiums. The hope of universal health care may or may not arise under the mandate but new dilemmas and hardships on U.S. citizens will undoubtedly surface.

There are over 45 million people in the United States who are uninsured when it comes to healthcare. Many are uninsured due to the expensive health care costs. To combat this, the Obama Care administration created the Patient Protection and Affordable Care Act to provide nationalized healthcare. The Affordable Care Act is meant to expand health coverage, lower health care costs and hold insurance companies accountable. The Affordable Care Act will allow more people to be insured but the issue lies in the question, do the costs outweigh the benefits? The Affordable Care Act will be used in an attempt to lower health care coverage costs for citizens. An example can be seen from a report in the Kaiser Family Foundation. The premium is required

The passage of the Affordable Care Act in 2010 allowed for comprehensive health insurance reform that shifted the imperative for care delivery and reimbursement from a volume to a value-based approach. The Center for Medicare and Medicaid Innovation (CMMI) under CMS has been at the forefront of developing and testing innovative payment models that would support the premise of expanding access to beneficiaries and achieving better quality outcomes while lowering exorbitant spending. One such model, named the Independence at Home (IAH) Demonstration, was deployed through ACA section 3024, with the aim of transforming the way primary care is delivered. This demonstration project builds on the success of the Veteran’s Administration Home-Based

Cheryl has been diagnosed with Generalized Anxiety Disorder, Major Depressive Disorder, and Alcohol Use Disorder. When asked about her concerns for post discharge she states that she has been heavily reliant on her parents and their health benefits for her treatment and that she is nervous that she may not have coverage to continue therapy. She reports that she felt safe knowing that “Obamacare” would be in place to help her afford the treatment she needs to stay mentally healthy and sober. She states that she is concerned about the possible repeal of the Affordable Care Act because she will need help paying for her mental health expenses. The Affordable Care Act made a giant leap in extending the work of the Mental Health Parity and Addiction Equity Act. These two acts work together to ensure that treatment for mental illness is accessible to many Americans that need treatment. Throughout this paper I

I just spoke with Mrs. Hornsby's regarding her issues. Her main concern was locating a Blue Advantage Plus Silver HMO Primary Care Physician who is accepting new patients. I walked Mrs. Hornsby's through our Provider Finder and we were able to locate multiple PCP's listed as accepting new patients with 25 miles of her home. She stated she would call them next week and see if she can get an appointment with any of them. She stated she has plenty of medication but simply needs to establish as a new patient with a PCP as her Specialist has advised her she needs to start having services rendered by a PCP. She asked if we have any PPO network plans and I explained to her that the Blue Advantage HMO is the only network available for the Individual

The current US Health Care delivery system Affordable Care Act (Obamacare), allows its citizens access to healthcare by NPs who practice autonomously providing healthcare to underserved rural populations, and in clinical settings, (McClelland, 2014; Stanley, 2011). The term autonomously and under prescriptive authority allows the NP establish realistic outcome measures, prescribe medications to provide secure, real, patient centered, appropriate, effective and reasonable care without a physician. Tiplady and Cook, (2015) stated that “outcome-based practice focuses on what an individual wants to achieve, and not only what the service wants to achieve (p. 406). For example the NP and the San Rafael patient in their relationship establish

Toward the end of the 1920s, in a little town in South Texas named Cotulla, a junior high teacher saw the injustice and poverty among his Mexican-American students (Del Bosque, 2013). After decades passed, that same man became the U.S. President; Lyndon B. Johnson signed the bill that constructed Medicaid in 1965, which is a program that is funded by the state and the federal government to provide health insurance to low-income Americans (2013). Johnson had an idea to create a “Great Society” which he defined as “a society where no child will go unfed, and no youngster will go unschooled” (2013) . Now even in 2015, we see that President Obama is still fighting for this dream of Johnson’s (Ura & Walters, 2014). President Obama’s Affordable Care

Josh Sutter and his wife Elizabeth call to enroll in a Medicare Advantage plan. They have just lost employer coverage with Elizabeth’s job since she just turned 65 and has retired. Agent Nancy Prigge verifies HIPAA compliantly with both Josh and Elizabeth, who are on speaker phone. Nancy goes on to ask for the couple’s PCP. Josh states he sees Dr. Kristina Anderson and Elizabeth states she’s a patient of Dr. Dennis Patton.

The Affordable Care Act (ACA) has been the biggest milestone to date in American health care policy (Saldin, 2011). There is nothing more complex or controversial in recent history than the passing of the ACA in 2010 (Davidson, 2016). The United States Supreme Court ratified the constitutionality of the Patient Protection and Affordable Care Act on June 28, 2012. With this, there were certainly challenges facing the full implementation of the provisions of this act by 2014.

It was in 1977 that the United Healthcare United Health group was founded by Richard Burke. The headquarters of the company are in Minnetonka, Minnesota. This organization works towards the betterment of people's health, it help them in living a healthy life by providing them with the kind of health care that would be best for them. The main focus of United Healthcare which is a major division of the United Health group is to provide the people with better health benefits and coverage.

Blue Cross Blue Shield does have a strong presence in the insurance community, whether that is in the Choices program, Medicare, or private policies. Government restrictions are a significant barrier to entry in multiple venues of healthcare. Brand loyalties and government restrictions are both barriers to entry in this situation.