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5 Cards in this Set
- Front
- Back
MANAGED CARE PRODUCT EVOLUTION (page 3)
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1. Traditional indemnity plans
2. HMO Plans Lower costs limited provider access utilization control 3. PPO Plans Lower costs than indemnity plans but full provider access 4. The POS Plan Like an HMO but with full access. 5. (Coming Soon) “Tiered Network” products. |
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REASONS WHY A NEW TYPE OF PRODUCT IS NEEDED
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1990’s initiatives (negotiation and UM) only caused one-time drops in trend
Health trend exceeds GDP (proxy for corporate revenue) Hospital trends are highest of all. HMO trends are as high as Indemnity now. directing ees into an HMO doesn’t save costs. MCO’s ability to negotiate discounts has decreased, b/c: Networks grew Can no longer promise providers increased volume (since patients freer) Incentives based on cost have led to legal problems |
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THE NEW PRODUCT: TIERED NETWORKS WITH DIFFERENTIAL COST SHARING
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hospitals rated by cost, quality, and efficiency (value)
grouped into most-preferred, preferred, unpreferred, and out-of-network. Patients have free choice But pay less for more preferred hospitals. |
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THE HOSPITAL SCORECARDING SYSTEM
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Cost Measures
Charges per Day; per Admission Quality Measures Mortality, complications, infections Efficiency Measures Unnecessary bed days Adjusted for case mix and severity mix. |
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ADVANTAGES OF THE PROPOSED HOSPITAL SCORECARD AND TIERED NETWORK STRATEGY:
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Patients “financially vested” in the costs of care
Patients understand the reason for copays. Hospitals can’t deny their results Negotiation easier. Reduced administration costs Quality and Efficiency rewarded. fewer legal and public relations problems hospitals motivated to reduce complication rates. Done. |