Assume The Role Of A Consultant Advising A Benefits M 791562

Assume the role of a consultant advising a benefits manager for a local telecommunications organization

Assume the role of a consultant advising a benefits manager for a local telecommunications organization. The company is self-funded and has 25,000 employees, dependents, and retirees eligible for health benefits. The employees are currently enrolled in a managed PPO plan administered by a commercial insurer. The employer’s health plan costs have increased by 15% over the prior year. Therefore, leaders are considering more cost effective options.

Identify at least three (3) managed care options that the organization would consider to be cost effective. Next, compare the three (3) options and make a recommendation based on your comparisons. 200 words

Paper For Above instruction

In response to rising healthcare costs, particularly the 15% increase experienced in the previous year, the telecommunication organization must explore cost-effective managed care options. Three viable strategies include Health Maintenance Organizations (HMOs), Exclusive Provider Organizations (EPOs), and Reference-Based Pricing (RBP).

HMOs are known for their capitation payment model and emphasis on preventative care, which can significantly contain costs through network restrictions and emphasis on primary care management. They often yield lower premiums and out-of-pocket expenses for employees (Garrett & Seward, 2020). EPOs, similar to HMOs but with more provider flexibility within an exclusive network, also offer a cost-effective alternative with predictable costs but are limited in provider choice (Kaiser Family Foundation, 2021). RBP, which sets reimbursement at a certain percentage above the Medicare rate, can drastically reduce expenses by controlling reimbursement rates across providers, although it may result in limited provider network access and potential quality concerns (Carroll et al., 2022).

When comparing these options, HMOs generally provide the lowest cost due to their preventive focus and network restrictions, but they may be less flexible for employees. EPOs offer a balance of cost savings with some provider flexibility, appealing to employees valuing choice but still maintaining cost control. RBP maximizes cost savings but poses risks around provider availability and care quality.

Based on these considerations, implementing an HMO plan could be the most advantageous. It provides substantial cost containment, emphasizes preventive care to reduce long-term expenses, and aligns well with the company's goal of cost efficiency. Additionally, offering a choice between an HMO and a traditional PPO can accommodate employee preferences while managing overall costs effectively.

References

• Garrett, B., & Seward, J. (2020). The impact of healthcare system reforms on managed care organizations. Journal of Health Economics, 68, 102236.
• Kaiser Family Foundation. (2021). Health insurance coverage and provider networks. Retrieved from https://www.kff.org
• Carroll, A., Smith, S., & Lee, M. (2022). Reimbursement strategies in reference-based pricing: An analysis. Health Policy Journal, 16(4), 320-329.
• Chen, A., & Wang, Y. (2019). Cost containment strategies in self-funded health plans. American Journal of Managed Care, 25(3), e88-e95.
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