Business > CASE STUDY > Financial_Recourse_Management_in_Healthcare.docx C428 Financial Recourse Management in H (All)

Financial_Recourse_Management_in_Healthcare.docx C428 Financial Recourse Management in H

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Financial_Recourse_Management_in_Healthcare.docx C428 Financial Recourse Management in Healthcare- C428 Performance Assessment RCP1-Task 1 A1. As Chief Financial Officer of Seamus Company, the d... ecision to move away from a fee-for-service model towards a managed care organization has been reviewed. To support the company goals, the proposed managed care strategies are as followed: Preferred Provider Organization, Health Maintenance Organization, and Exclusive Provider Organization. The first of the three fiscally sustainable strategies are the Preferred Provider Organization (PPO). Preferred Provider Organization is a combination of cost-saving strategies like a Health Maintenance Organization, but with some additional features of the traditional insurance plans. When choosing a PPO plan, the recipient is allowed to select his or her own providers, however beneficiaries are encouraged to use providers that take part in the plan. This approach is a cost sharing strategy that encourages members to visit participant physicians within the PPO plan, although not enforced. This is how an organization has the ability to cut healthcare costs is by coming to an agreement with assigned providers. A preferred provider pays an increased cost share for services that are provided within the network rather than those services provided outside the network, which may result in higher premiums and employees deductibles. That is why a Preferred Provider Organization costs tend to be more expensive verses other insurance plans. Anot. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .. .. . . . . . . . . . . . . . . . . . .. . . . . [Show More]

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