National Health Coverage Plans, Reimbursements, and Quality

For this assignment, you will examine the importance of healthcare coverage (insurance). You will also examine how reimbursements (payments) from health plans are impacted by quality of care. Start by selecting two major national (U.S.) insurance health plans. You may choose Medicaid, Medicare, HMO, PPO, or private insurance plans. You can choose your own personal insurance plan if you prefer. You will review coverage options offered by both plans that benefit and hinder patient’s access to care. Examples of coverage options that facilitate or limit access include medication coverage, primary care physicians, specialists, emergency care, lab or blood work and diagnostics, wellness care, prevention services, surgery (these are just a few examples). You will also explore the role of Diagnosis Related Groups (DRGs) and charity care within healthcare facilities and how charity care impacts the vulnerable or uninsured population.

**We will not discuss deductibles and costs of the plans as this will not be the focus of this this assignment.

This assignment requires a minimum of four current (no more than 10 years old), relevant, peer-reviewed, references. Prepare a 3-5 page (does not include title page and references page) APA formatted paper (no more than 5 pages) addressing the following:

Introduction

Write an introductory paragraph that describes the importance of healthcare coverage (insurance). End with a clearly worded purpose statement.

Healthcare Coverage and Vulnerable Populations

Discuss two ways healthcare coverage would be beneficial (helpful) for the vulnerable/ uninsured populations.

Select a Major Healthcare Plan – (Label heading with the name of the plan Ex: Preferred Provider Option Plan)

Summarize two care options provided by the plan that facilitates access for the patient. Summarize two care options that limit access to care for the patient.

Select a Second Major Healthcare Plan – (Label heading with the name of the plan)

Summarize two care options provided by the plan that facilitates access for the patient. Summarize two care options that limit access to care for the patient.

Diagnosis Related Groups

Describe the purpose of Diagnosis Related Groups (DRGs). Explain the impact of DRGs on length of stay and payment of services. Discuss how payments for DRGs are now impacted by quality of care.

Charity Care

Describe the role of charity care within an acute care health facility (hospital). Discuss how vulnerable populations and the uninsured are helped (impacted) from the charity care provided by healthcare facilities (hospitals). Explain how charity care can benefit the facility.

Conclusion

Summarize key points of your paper.