Group Health Care: A Case Study

Superior Essays
Reimbursement for group medical care continues to be problematic in private sector (Dickman, 2012). As of current, Medicare and many insurers do not reimburse SMAs (Dickman, 2012). Policy makers play a key role in realigning financial incentives so that group visits are reimbursed for public and private insurance as routine part of primary care so that all people have access to SMA services. The SMA approach addresses how to implement chronic care management when faced with a shortage of providers in underserved regions.
Because of current fee-for-service reimbursement in primary care settings, it is difficult to sustain group visits to focus on self-management and behavior change. Arguably, privately owned medical offices face financial
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These programs are effective ways for providing low cost services for patients with diabetes but also for healthcare providers and healthcare institutions. Siminerio, Zgibor, & Solano Jr, (2004) highlighted that a 30 minutes diabetes training group visits is reimbursed by the Medicare for 18.36 dollars versus individual diabetes training for 31.37 dollars. Furthermore, the MNT is reimbursement for a 30 minute group service for 11.08 dollars versus 15 minutes individual nutrition therapy for 14.15 dollars per session. Using a systemic review analysis, Edelman et al( 2014) dispute the impact of SMAs on utilization and cost, underlining that some studies suggested hospitalization was lower in patients with diabetes that participate in group visits, but results from various studies were often mixed and preliminary (Edelman, 2014). Health and economic performance are interrelated systems therefore integrating effective programs in the diabetes management will lower the costs and will support the sustainability of the SMAs in the current fiscal …show more content…
In the same fashion, the other group members have to trust each other when disclosing personal and medical information as part of group interaction. Privacy is an important aspect of medical encounter in which the patient share personal and private information with the provider for medical purpose only. In the SMA model, the patient privacy is reduced because of the presence of other group members that listen to the information divulged. Handling information in the SMAs can raise the issues of breaching the confidentiality as result of private conversations shared with other patients. According to Wong et al (2013) there are regular renegotiations in the SMA with the purpose of maintaining strict confidentiality among the group members. One important feature of the SMA is the informed consent that is obtained at the beginning of the first session by explaining what the model encompasses and how this medical model benefits the patient giving the medical circumstances. Moreover, in the SMA provider promotes patient voluntary decision making by offering the option to choose between traditional care and this medical care model. Despite the potential for certain ethical concerns, SMA has a great potential for increase efficiency, and patient and provider satisfaction (Wong et

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