This Week's Assignment: Further Explore Healthcare ✓ Solved

This Weeks Assignment You Will Further Explore The Healthcare Delive

This week’s assignment requires you to further explore the healthcare delivery model. Use the provided template to answer the questions. The answers to these questions may be found in your readings, especially the article linked below. Please remember to click on the embedded links in the article as well because there is additional information there about the specific delivery model.

Read the following case study, and then follow the instructions on the template. You will determine how Mildred’s experience will differ based on the healthcare delivery model.

Case Study: Mildred is an 84-year-old Caucasian woman of German descent who has six children. She was married for 47 years before her husband died of cancer. She rarely travels due to her age, but she decided to visit her son in Phoenix, Arizona, for her granddaughter’s 18th birthday. During her visit, Mildred was bitten by a spider. Initially, she thought nothing of it, but later her hand swelled up, prompting her to visit the nearest Urgent Care. The doctor there referred her to the Emergency Department due to her symptoms.

Mildred was admitted to the hospital for intravenous antibiotics and was later diagnosed with a chronic heart problem. Following treatment, she felt much better but was worried about potential bills from her hospitalization. Based on the scenario, answer the questions on the template, particularly considering which healthcare delivery model (HMO, PPO, POS, EPO, PFFS, SNP or ACO) you would prefer for Mildred and which you believe would be the worst for her situation.

Paper For Above Instructions

In the context of Mildred’s case, selecting an appropriate healthcare delivery model is crucial for ensuring that she receives effective care without undue financial burden. Mildred’s age, health condition, and recent hospitalization make it essential to choose a model that offers comprehensive coverage and manages costs effectively.

Understanding Health Care Delivery Models

Health care delivery models can significantly vary in terms of cost, flexibility, and access to care. This exploration focuses on Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Point of Service (POS) plans, Exclusive Provider Organizations (EPOs), Private Fee-for-Service (PFFS) plans, Special Needs Plans (SNPs), and Accountable Care Organizations (ACOs).

Preferred Model: ACO for Mildred

Considering Mildred's health needs and her recent medical emergency, the best healthcare model for her would be an Accountable Care Organization (ACO). ACOs are designed to enhance care coordination and encourage collaboration among healthcare providers. This model focuses on maintaining the health of enrolled patients while minimizing costs through preventative care and reduced hospital admissions (Bendavid et al., 2015).

For an elderly patient like Mildred, the ACO offers several benefits. First, it emphasizes continuity of care, which is crucial given her existing chronic heart condition and potential follow-ups after hospitalization. ACOs often provide integrated services that can assist in managing her overall health, including specialists, which can effectively reduce the complexity of navigating her care (Shin et al., 2019).

Furthermore, ACOs typically offer reduced out-of-pocket costs for patients while implementing care practices that ensure patients receive necessary services without unnecessary interventions (Baker et al., 2018). For Mildred, a focus on value-based care means that her health provider would be incentivized to ensure efficient treatment rather than maximizing service quantity.

Least Preferred Model: HMO for Mildred

Conversely, the worst healthcare model for Mildred would likely be a Health Maintenance Organization (HMO). While HMOs often provide lower premiums and out-of-pocket expenses, they require members to use a network of doctors and hospitals, which could limit Mildred's access to specialized care that may be necessary for her chronic condition (Cohen et al., 2017).

Given Mildred's acute healthcare needs resulting from the spider bite and subsequent heart diagnosis, the restrictions imposed by an HMO could hinder her access to timely and potentially life-saving treatments (Gold & Soni, 2018). Additionally, the requirement for a primary care physician referral to see specialists might delay her access to necessary care (Ginsburg & Grossman, 2018). Such delays could lead to worsening health outcomes, particularly for a patient with multiple health issues.

Financial Security and Peace of Mind

Mildred's concern about bills following her hospital stay further highlights why an ACO would be more beneficial. ACOs are geared towards minimizing unexpected costs, making healthcare more predictable and manageable for patients (McCarthy et al., 2016). In contrast, the nature of HMOs could expose Mildred to higher out-of-pocket expenses, particularly if she needs additional services that fall outside her assigned care network.

Conclusion

In conclusion, for Mildred’s health situation and financial security, an Accountable Care Organization is the most suitable healthcare delivery model due to its focus on integrated care, cost-effectiveness, and improved access to necessary services. On the other hand, a Health Maintenance Organization would likely hinder her access to specialized care and induce anxiety over unexpected medical bills. Ultimately, understanding these models enhances the decision-making process regarding health care, especially for older adults facing complex health challenges.

References

• Baker, S. M., et al. (2018). The evolving role of accountable care organizations in chronic disease management. Health Affairs, 37(3), 471-478.
• Bendavid, E., et al. (2015). The impact of accountable care organizations on health care costs and quality. The New England Journal of Medicine, 373(1), 43-49.
• Cohen, M. A., et al. (2017). Understanding the implications of HMOs and ACOs for patient care. Journal of Health Care for the Poor and Underserved, 28(2), 603-620.
• Ginsburg, P. B., & Grossman, J. M. (2018). The limitations of HMOs and the emergence of alternative care models. Health Affairs, 37(8), 1302-1309.
• Gold, M., & Soni, A. (2018). Health maintenance organizations: The pros and cons. American Journal of Managed Care, 24(9), 425-430.
• McCarthy, D., et al. (2016). The rise of accountable care: Implications for patients' financial security. The Commonwealth Fund, 1, 1-7.
• Shin, P., et al. (2019). Accountable care organizations and care coordination: The future of health care. Journal of Health Care for the Poor and Underserved, 30(1), 29-45.