Southside Hmo Case Study

Nutrition and Food Services at the Miami VA Healthcare System is managed as a team by all supervisors. The managers that run the Nutrition and Food Services (NFS) at the Miami VA include the Food Service Systems Manager, Veteran Experience Systems Manager, Clinical Nutrition Manager and the Assistant Chief/Operations Manager. The Chief of NFS, who is a registered dietitian, is responsible for establishing guidelines and ensuring compliance to provide a safe food supply for all patients and residents in the Community Living Center (CLC) according to their medical and nutritional needs. Clinical service procedures and organization is the main responsibility of the Clinical Nutrition Manager. Nonetheless, all the managers, Assistant Chief and Chief are involved in making important decisions in each nutrition and dietetic position.

The best way to view a Medicare HMO directory is through the search portal on the Medicare website. Features include a general search by zip code or a personalized search using a date or birth, zip code and Medicare number. Detailed search results provide Medicare users with HMO organizations, their ratings, information about premiums, deductibles and drug coverage. Compare different HMO plans by choosing providers; charts display drug costs, program coverage, whether there is a choice of doctors and the maximum of-of-pocket expenses.

The issue is that it is very difficult to assess the overall competence and voluntariness of a patient. CMA mandates that the protection of physicians is a must; and any change in law must legally protect those physicians who choose to participate from criminal, civil, and disciplinary proceedings. No physician should feel compelled to participate, and patients are free to transfer to another hospital if a physician denies a patients

You are a new physician setting up your practice in a new town. You are researching the different MCOs offered in your area and are considering becoming a physician for one of these networks. You have also invited the sales representatives of several healthy plans to speak with you about the benefits of choosing their plans. Based on the above scenario, answer the following questions: • What effects would join an MCO have your clinic regarding staffing, patient volume, and financial stability?

While it is the responsibility of the health information management (HIM) department to cooperate with law enforcement in the event of a crime, this can still be achieved without a Health Insurance Portability and Accountability Act (HIPAA) breach. HIM department managers must maintain protection of patient privacy when delivering reports to the public. In the case involving Memorial Hermann Health System (MHHS), there were many causes of action the patient had against MHHS. Those include, but are not limited to, invasion of privacy, malpractice, defamation, negligence for improper disclosure and breach of confidentiality.

Once the ailment is treated, patients are referred back to their primary care physician or a specialist for ongoing care. Therefore, I propose that the Northwell Health GoHealth Urgent Care Centers incorporate a multitude of specialties and expand their services outside of the urgent

To top all those challenges, it is important to remember that the company is into government managed healthcare system, which is always hard and impossible to establish changes, based on layers of bureaucracy. Triwest Healthcare Alliance has enacted some tools and techniques to attract and retain customers, which requires challenges, dedication, investment, and patience. In addition to customers, the company must satisfy its army of healthcare providers, because without them, it will be out of business. Furthermore, the company must be able to recruit and retain more healthcare providers; those providers are its core competency and must be satisfied with how they are being treated by the company.

According to a provision under the ACA, Medicare would be remunerating healthcare organizations from the savings acquired through care quality enhancement and cost reduction. It is mandatory for all the health care organization to be transformed into Accountable Care Organization to promote this shared savings program. This model also has a dominant contribution to a skillful patient treatment during the care course. Some affiliates of a particular accountable care organization provide health care same means to all the practitioners, hence the medical tests and appointments are conducted under that. If a patient pursuing second opinion or any specialist’s opinion rather than the insight of a primary care physician, he will be referred to the specialist within that organization in order to keep the patient from incurring additional

We accomplished this through interviews with clinic leaders. The purposes of these interviews were twofold: Firstly, to evaluate the plausibility of our findings and secondly to understand the key differences between the PCMH and non-PCMH clinics in regards to the availability of the PCMH attributes. Among all the responses, “access to care” was most frequently cited by experts. By operating with extended office hours, including weekends, and a helpline available to their patients, the PCMH clinics offer accessibility to those who would otherwise not have access to care. A good example is people with disabilities for whom they usually need assistance from family members or friends to commute or travel.

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Managed Care Organization (MCO) is healthcare delivery system that attempts to keep cost down by managing the care to eliminate unnecessary treatment and reduce expensive hospital care. The most familiar models are HMOs and PPOs. Indemnity Plan also called (fee-for-service) is the type of plan most Americans were covered under until tha past two decades. Under this plan patients can go to any healthcare provider or hospital they choose, medical bills are sent to the insurance carrier, and the patient or (healthcare provider) is reimbursed according to rules of the

“Managed Care is a health care delivery system organized to manage cost, utilization, and quality (Medicaid, n.d).” Managed care is set up for easy affordable access to healthcare, the care is regulated so that needed procedures are performed on the patients within the limits of network providers available. There are many undesirable and helpful aspects of managed care. For example, a managed care system provides lower costs, quality service, employer opportunities to make available insurance for their employees, in network provider connections allowing for easy finds of doctors for the patient’s specific plan (Cyrene, n.d). There are however many disadvantages, those include not having the accurate provider or lack of provider for the required

Also, it is anticipated that the synergistic integration and active involvement of these providers in the care of patients and families, may improve healthcare outcomes and resource allocation overall. Specifically, this research will contribute to the health system

Health Maintenance Organization (HMO) There are four basic types of managed care plans that fall under the umbrella of a Managed Care Organization. The first type is a Health Maintenance Organization (HMO). An HMO is the most common type of MCO and it mainly focuses on wellness (Stark 2014). HMOs contract with different health care providers who become part of a network that provides health services to HMO patient members at a fixed, prepaid fee regardless of actual medical costs or the amount of times they are seen in the office (Stark 2014).

Hello Cat, Thank you for connecting with me on LinkedIn. I am a graduate accounting student from Indiana University the Kelley School of Business. My senior year in college, I had done researches about the costing issues in the healthcare sector and thus developed a strong interest in this industry. This past summer, I interned with a Pharmaceutical company in Louisville, KY. I learned about your organization from the school career website.