Posted: September 11th, 2017

What obligation, if any, does an employer, and/or MCO have to educate subscribers in how to interpret performance data?

Many consumer and health care advocacy initiatives are converging toward a mandate to provide public access to many types of information about managed care organization (MCO) performance, costs, and quality. In fact, employers in the many parts of the country who are the major purchasers of health insurance are now requiring MCOs to make “health plan performance data” available to subscribers to facilitate their choice of plans. · Discuss and provide the rationale for your opinion on providing data in areas such as patient outcomes, compliance with national standards for preventive and chronic care, and comparative costs to the public. · What obligation, if any, does an employer, and/or MCO have to educate subscribers in how to interpret performance data? At whose expense should such education be provided? · What are the possible benefits or disadvantages to making such performance data available to the public? Discussion Question 2: · Select ONE of the topics below and describe how it has affected the costs of health care in the US? o The health insurance industry o Advances in medical care technology o Changes in U.S. demographics o Government support for health care o Consumer expectations Assignment: Professional Development Assignments: (60 points) 1. Managed care organizations emphasize physicians’ responsibilities to control patient access to expensive hospitalization and specialty care, a principle dubbed “gatekeeping.” Some argue that “gatekeeping” is unethical because it introduces financial factors into treatment decisions. Others say it improves quality by promoting the use of the most appropriate levels of care. Take a position on this issue and explain your view. 2. If we accept the premises that resources available to meet the costs of health care are finite, and that continuing to increase dollars allocated for health care expenses carries “opportunity costs” for the nation and society, discuss your position on the following: As a national policy should we allocate a set level of resources and apply them to achieving “the greatest good for the greatest number” (necessarily leaving some out) OR should we adopt the individualist approach of “those who can pay get, those who can’t, don’t”? 3. Medicaid is shouldering an ever-increasing burden of cost for long-term care for the elderly, with enormous impacts on state budgets throughout the nation. Discuss alternatives to ease this drain on Medicaid resources. Each response should be 500-1000 words

 

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