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(Solved) How Health Care is Organized Part 2 Early 20th Century Model Multi Specialty Groups Mayo Clinic Employed Geisinger model Collaborative practice Group...


Please review the PowerPoints, How Health Care is Organized, Parts I and II.

Answer the question in Slide 15 in Part I:

  • "If you had all that money [sic], how would you establish a health department in a new country?" {If you have ever played Civilization, this is the idea.}

Answer the question in Slide 14 in Part II:

  • "What are patients looking for?" --in the U.S., and in other parts of the world?

Your total response should be a minimum of 500 words and maximum 750 words in length and written in paragraph(s) form. Use APA as needed.  One resource that might be helpful is the World Health Organization, at http://www.who.int/en/

** please use in-text citations as needed to reflect the references 

How Health Care is Organized
Part 2 Early 20th Century Model Multi Specialty Groups Mayo Clinic
Employed Geisinger model Collaborative practice Group functioned as PCP 1932 Committee on Cost of Medical Care Recommended large group practice Resisted by professional societies Hospitals provided referral network and necessities. Early 20th Century Model Community Practices Health Centers Primary Care Regionalized services planned on a
geographic basis Public health nursing plays primary role. Declined as hospital became more central. Revived during 1960s War on Poverty. Federally Qualified Health Center Early 20th Century Model KAISER Health First Generation HMO – Insurer Operator of Hospitals Multi-specialty Medical Group Began with Kaiser paying a physician a
prepaid fixed sum per worker on the Coulee
Dam project. Now physicians are salaried and hospital on
a global budget 2nd Generation HMO IPA model Independent Practitioner
Association Contract with employers for a monthly
payment per enrollee Paid physician discounted fee for service Conducted Utilization Review HMO Act of 1973- Nixon Required large and medium sized
businesses that provided health
insurance to their employees to offer a
federally qualified HMO if one was
available. Allowed growth of HMO movement Maintained traditional mode
of payment. IPA’s Physicians retain ownership of their
individual practices but agree to
participate in association for purposes of
contracting. Is not collusion Can accept capitation Can have numerous relationships
causing confusion. Integrated Medical Group Physicians do not own their practice Contract with multiple managed care
plans Many established by hospital to
generate referrals. Virtual Integration Contracting Virtual Integration Greater flexibility than vertical integration Can respond quickly to changing
environment Don’t carry heavy cost of “bricks and
mortar” Components can win and lose, based on
cost containment. Point of Service Plan (POS) Patient can see someone who is out of
network for higher out of pocket
payment. Increased flexibility with increased cost. Preferred Provider (PPO) Like POS higher payment for out of
network providers Pay contracted panels of providers on a
fee for service basis and financial risk
remains with the PPO not the provider. Providers hope to receive more patients
by being on preferred list. What are Patients Looking For?

 


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