MHA507 Module 1 – SLP

Health Care Delivery System in the United States

The overall goal of the Session Long Project in this course is to examine health care delivery in the United States from a personal perspective, and provide recommendations for improvement.

As U.S. citizens, we have all interacted (and will continue to interact) with the delivery of health care. In fact, insurance plans/organizations are an important part of our healthcare delivery system. Most healthcare insurance plans are either an Exclusive Provider Organization (EPO), Health Maintenance Organization (HMO), or Preferred Provider Organization (PPO). It is important to note that health insurance is highly government regulated, and, as a result, is influenced by political culture.

View the following video:

JS Downey Insurance Service. (2015, April 8). Understanding HMO, PPO, and EPO plans [Video file]. Retrieved from https://www.youtube.com/watch?v=_AqIaoxouks

Read the following article:

Schroeder, S. A. (2014). Physicians, politics, and health insurance expansion. Journal of General Internal Medicine, 29(2), 267-8.

For the Module 1 Session Long Project, complete the following:

Part 1:

In at least 2 pages, explain the type of health insurance coverage you currently have (you do not need to provide the name of your insurance company):

· Insurance Product (e.g., HMO, PPO, POS, Indemnity, or others)/Self-pay if not insured.

· Source (employer, government, parents, or others).

· Out-of-pocket costs: co-payments, deductibles, expenses, etc.

· Level of coverage (e.g., 100% coverage or 80% coverage with 20% coinsurance).

· Major limitations on choice of providers or self-pay: (a) Are you required to choose a primary care physician? (b) Are there limitations on use of out-of-network providers? (c) What are the limitations to self-pay?

Part 2:

As noted, U.S. political culture has an influence on the U.S. health care delivery system. Draft a 1- to 2-page memo to your local politician or lobbyist expressing the limitations stated in Part 1. Make recommendations on how political culture and values can either reduce these limitations or further increase them.

SLP Assignment Expectations

1. Conduct additional research to gather sufficient information to support your response/position.

2. Limit your paper to 3-4 pages.

3. Support your SLP with peer-reviewed articles, using at least 3-4 references. Use the following source for additional information on how to recognize peer-reviewed journals:  http://www.angelo.edu/services/library/handouts/peerrev.php.

4. You may use the following source to assist in formatting your assignment: https://owl.english.purdue.edu/owl/resource/560/01/.

Module 1 – Background

Health Care Delivery System in the United States

Required Reading

Centers for Medicare & Medicaid Services. (2013). Lower costs, better care: Reforming our health care delivery system. Retrieved from https://www.cms.gov/newsroom/fact-sheets/lower-costs-better-care-reforming-our-health-care-delivery-system-0

Department for Professional Employees. (2016). The U.S. health care system: An international perspective. Retrieved from http://dpeaflcio.org/programs-publications/issue-fact-sheets/the-u-s-health-care-system-an-international-perspective/

Professional Eye Care Associates of America. (2014). Different types of health insurance models. Retrieved from: http://www.pecaa.com/wp-content/uploads/2014/11/Different-Types-of-Health-Insurance-Models.pdf

Institute of Medicine (US). (2002). Chapter 5: The health care delivery system. In The future of the public’s health in the 21st century. Washington D.C.: National Academies Press. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK221227/

Lee, T. H., & Berenson, R. H. (n.d.). The organization of health care delivery. Retrieved from https://cdn.americanprogress.org/wp-content/uploads/issues/2008/10/pdf/health_delivery_ch2.pdf

Ridic, G., Gleason, S., & Ridic, O. (2012). Comparisons of health care systems in the United States, Germany and Canada. Materia Socio-Medica, 24(2), 112–n/a.

Schroeder, S. A. (2014). Physicians, politics, and health insurance expansion. Journal of General Internal Medicine, 29(2), 267-8.

Squires, D., & Anderson, C. (2015). U.S. health care from a global perspective. Retrieved from http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective

Videos

Coronado, L., Crosby, A., Rascano, T., Saechin, T., Salazar, L., & Taylor-Weber, J. (2014, July 29). The Healthcare System in the United States [Video file]. Retrieved from https://www.youtube.com/watch?v=nRFKCXvy3-g.

JS Downey Insurance Service. (2015, April 8). Understanding HMO, PPO, and EPO plans [Video file]. Retrieved from https://www.youtube.com/watch?v=_AqIaoxouks

Optional Reading

Nyman, J. A., & Trenz, H. M. (2016). Affordability of the health expenditures of insured Americans before the Affordable Care Act. American Journal of Public Health, 106(2), 264–266.

Module 1 – Outcomes

Health Care Delivery System in the United States

· Module

· Assess the major components of the U.S. health care delivery system.

· Case

· Evaluate the U.S. health care system and employ critical thinking to fractionize trending assumptions.

· SLP

· Evaluate health care delivery system from an individual perspective and evaluate the impact of political culture.

· Discussion

· Assess a prominent statement concerning the U.S. healthcare system and formulate a position in support or against the statement.

aDDITIONAL INFORMATION

Course Materials/Bibliography

Module 1

Required Reading

Centers for Medicare & Medicaid Services. (2013). Lower costs, better care: Reforming our health care delivery system. Retrieved from https://www.cms.gov/newsroom/fact-sheets/lower-costs-better-care-reforming-our-health-care-delivery-system-0

Department for Professional Employees. (2016). The U.S. health care system: An international perspective. Retrieved from http://dpeaflcio.org/programs-publications/issue-fact-sheets/the-u-s-health-care-system-an-international-perspective/

Professional Eye Care Associates of America. (2014). Different types of health insurance models. Retrieved from: http://www.pecaa.com/wp-content/uploads/2014/11/Different-Types-of-Health-Insurance-Models.pdf

Institute of Medicine (US). (2002). Chapter 5: The health care delivery system. In The future of the public’s health in the 21st century. Washington D.C.: National Academies Press. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK221227/

Lee, T. H., & Berenson, R. H. (n.d.). The organization of health care delivery. Retrieved from https://cdn.americanprogress.org/wp-content/uploads/issues/2008/10/pdf/health_delivery_ch2.pdf

Ridic, G., Gleason, S., & Ridic, O. (2012). Comparisons of health care systems in the United States, Germany and Canada. Materia Socio-Medica, 24(2), 112–n/a.

Schroeder, S. A. (2014). Physicians, politics, and health insurance expansion. Journal of General Internal Medicine, 29(2), 267-8.

Squires, D., & Anderson, C. (2015). U.S. health care from a global perspective. Retrieved from http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective

Videos

Coronado, L., Crosby, A., Rascano, T., Saechin, T., Salazar, L., & Taylor-Weber, J. (2014, July 29). The Healthcare System in the United States [Video file]. Retrieved from https://www.youtube.com/watch?v=nRFKCXvy3-g.

JS Downey Insurance Service. (2015, April 8). Understanding HMO, PPO, and EPO plans [Video file]. Retrieved from https://www.youtube.com/watch?v=_AqIaoxouks

Optional Reading

Nyman, J. A., & Trenz, H. M. (2016). Affordability of the health expenditures of insured Americans before the Affordable Care Act. American Journal of Public Health, 106(2), 264–266.

Module 2

Required Reading

Andrews, M. (2014). What’s the best health plan for you? HMO, PPO, EPO or POS? Retrieved from https://www.washingtonpost.com/national/health-science/whats-the-best-health-plan-for-you-hmo-ppo-epo-or-pos/2014/08/25/772f96a8-27c1-11e4-958c-268a320a60ce_story.html?utm_term=.51bd23ba540e

Gabel, J., & Ermann, D. (1985). Preferred provider organizations: Performance, problems, and promise. Health Affairs, 4(1), 24–40.

Plunkett, L. (2015). Accountable care organizations. New York State Dental Journal, 81(3), 4–7.

Healthcare Transformation Institute. (n.d.). Healthcare delivery models. Retrieved from http://www.healthcaretransformationinstitute.org/page/healthcare-delivery-models

Haas, S. (n.d.). Health Reform Act: New models of care and delivery systems. Retrieved from https://www.aaacn.org/health-reform-act-new-models-care-and-delivery-systems

Humana. (n.d.). HMO vs. PPO: Which one is right for you? Retrieved from https://www.humana.com/all-products/understanding-insurance/hmo-vs-ppo

Rural Health Information Hub. (2017). Healthcare access in rural communities. Retrieved from https://www.ruralhealthinfo.org/topics/healthcare-access

Shi, L., & Singh, D. (2017). Chapter 1: Major characteristics of U.S. health care delivery. In Essentials of the U.S. health care system (4th Ed.). Burlington, MA: Jones & Bartlett Learning. Available in the Trident Online Library.

Videos

BrainForestTV. (2014, September 18). Accountable Care Organizations (ACOs) explained in 1 minute [Video file]. Retrieved from https://www.youtube.com/watch?v=flYzHZwDH_0

Humana. (2013, June 25). What are PPOs and HMOs? | Humana [Video file]. Retrieved from https://www.youtube.com/watch?v=ii2H5eCGxx8&pbjreload=10

FAIR Health. (2017, November 1). Point of service (POS) (Part 4 of 8)—FAIRHealthConsumer.org [Video file]. Retrieved from https://www.youtube.com/watch?v=gm5eKYjcZbc

TheMinaSara. (2015, December 21). History of managed care [Video file]. Retrieved from https://www.youtube.com/watch?v=SoExSvjPnh0

Optional Reading

Holman, P. (1985). Healthy competition: HMOs vs. PPOs vs. Blue Cross. Executive Report, 3(7).

Module 3

Required Reading

Al-Busaidi, Z. Q. (2008). Qualitative research and its uses in health care. Sultan Qaboos University Medical Journal, 8(1), 11–19.

Center for Innovation in Research and Teaching. (n.d.). An overview of quantitative research. Retrieved from https://cirt.gcu.edu/research/developmentresources/research_ready/quantresearch/overview_quant

Bleser, W. K., Miller-Day, M., Naughton, D., Bricker, P. L., Cronholm, P. F., & Gabbay, R. A. (2014). Strategies for achieving whole-practice engagement and buy-in to the patient-centered medical home. The Annals of Family Medicine, 12(1), 37–45.

Caldas de Almeida, J. M. (2015). Mental health services and public mental health: Challenges and opportunities. World Psychiatry, 14(1), 51–53.

Daaleman, T. P., & Fisher, E. B. (2015). Enriching patient-centered medical homes through peer support. Annals of Family Medicine, 13(Suppl 1), S73–S78

Howard, H. A., Malouin, R., & Callow-Rucker, M. (2016). Care managers and knowledge shift in primary care patient-centered medical home transformation. Human Organization, 75(1), 10–20.

Jarvis, A., Perry, R., Smith, D., Terry, R., & Peters, S. (2015). General practitioners’ beliefs about the clinical utility of complementary and alternative medicine. Primary Health Care Research & Development, 16(3), 246–253.

Magill, M. K., Ehrenberger, D., Scammon, D. L., Day, J., Allen, T., Reall, A. J., … Kim, J. (2015). The cost of sustaining a patient-centered medical home: Experience from 2 states. Annals of Family Medicine, 13(5), 429–435.

Patient-Centered Primary Care Collaborative. (n.d.). History: Major milestones for primary care and the medical home. Retrieved from https://www.pcpcc.org/content/history-0

Shin, P., Sharac, J., & Rosenbaum, S. (2015). Community health centers and Medicaid at 50: An enduring relationship essential for health system transformation. Health Affairs, 34(7), 1096–1104.

Videos

Genpact. (2017). What are the biggest challenges in healthcare today? [Video file]. Retrieved from http://www.genpact.com/insight/videos/what-are-the-biggest-challenges-in-healthcare-today

HPCAtube. (2012, April 25). What is a community health center? [Video file]. Retrieved from https://www.youtube.com/watch?v=kPLpNWO5uGs

Martin, M. (2014, February 10). Quantitative management in healthcare [Video file]. Retrieved from https://www.youtube.com/watch?v=v_7k3nKFIjs

Public Health Wessex Training Group. (2014, March 14). What is public health? [Video file]. Retrieved from https://www.youtube.com/watch?v=oy1CAMObRzc

SmithGroup. (2015, March 16). Ambulatory care center design [Video file]. Retrieved from https://www.youtube.com/watch?v=Cz5MxxvHMss

Optional Reading

Lockett, K. M. (2014). Integrating hospital and physician revenue cycle operations. Healthcare Financial Management, 68(3), 38–41.

Module 4

Required Reading

AARP. (2017). Medicare, Medicaid and ACA. Retrieved from https://www.aarp.org/ppi/issues/medicare/

Beckers Healthcare. (2013, February 8). 18 recent Medicare, Medicaid issues. Retrieved from https://www.beckershospitalreview.com/finance/18-recent-medicare-medicaid-issues-feb-8-2013.html

Center on Budget and Policy Priorities. (n.d.). Policy basics: Introduction to Medicaid. Retrieved from https://www.cbpp.org/research/health/policy-basics-introduction-to-medicaid

U.S. Department of Health and Human Services. (2016). What is the difference between Medicare and Medicaid? Retrieved from https://www.hhs.gov/answers/medicare-and-medicaid/what-is-the-difference-between-medicare-medicaid/index.html

Kaiser Health News. (2015, July 30). 5 challenges facing Medicaid at 50. Retrieved from the U.S. News & World Report website at https://www.usnews.com/news/articles/2015/07/30/5-challenges-facing-medicaid-at-50

Rajaram, R., & Bilimoria, K. (2015). Medicare. JAMA, 314(4), 420.

MedPAC. (2017). Report to the Congress: Medicare and the Health Care Delivery System. Retrieved from http://www.medpac.gov/docs/default-source/reports/jun17_reporttocongress_sec.pdf

Videos

NAAIP. (2016, April 27). Medicare explained in two minutes [Video file]. Retrieved from https://www.youtube.com/watch?v=i9wGIaKE6fA

NAAIP. (2015, December 13). What is Medicaid? Excellent explanation by a board-certified elder care attorney [Video file]. Retrieved from https://www.youtube.com/watch?v=O3uY8ycWbrQ

Optional Reading

Hofstrand, D. (2016). Vision and mission statements—A roadmap of where you want to go and how to get there. Retrieved from https://www.extension.iastate.edu/agdm/wholefarm/pdf/c5-09.pdf

Josiah Macy Jr. Foundation. (2008). Continuing education in the health professions: Improving healthcare through lifelong learning. Retrieved from http://macyfoundation.org/docs/macy_pubs/Macy_ContEd_1_7_08.pdf

OSHA. (n.d.). Education and Training. Retrieved from https://www.osha.gov/dsg/hospitals/education_training.html

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