#1

The Economics of Managed Care

Your employers have indicated that they are changing insurance carriers to an HMO because of the cost savings in premiums. They explain that your out of pocket costs may increase if you seek treatment from out of plan providers. You and the other employees are against the change since your current health plan meets your needs well and you have all decided that you would be willing to pay a higher percentage toward your contribution for health care to keep the existing plan.

What are the key points for and against making this shift? In your response, include your thoughts on how quality (for the employer and the employee) will be affected? Explain why?

What other considerations should employees and the employer consider when making this change?

Response Guidelines

Respond to the posts of any two of your peers. From the perspective of a professional working for an Health Maintenance Organization (HMO), how does this change in insurance carrier make sense? Give details. Explain why HMOs are the best option.

Respond to this question using available resources from your text, the Capella University library, and the Internet. Make sure to include the source citations and references for any outside sources used. This reply should be in approximately 250–400 words and in APA format.

#2

Negotiating a Successful Capitated Contract

You are the administrator for a large mixed specialty medical group and have been approached by the local HMO about accepting their pool of patients in a capitated contract.

What must you do to effectively negotiate a contract that will earn the group a profit? What demographic information is needed? How will you capture what type of risk you will have in this contract in terms of cost of delivering care?

Response Guidelines

Respond to the posts of any two of your peers. What demographic information did your peers possibly leave out? Make suggestions for successfully negotiating contracts to earn the group a profit.

Respond to this question using available resources from your text, the Capella University library, and the Internet. Make sure to include the source citations and references for any outside sources used. This reply should be in approximately 250–400 words and be in APA format.