Health Insurance Open Enrollment Hi Staff, Happy New Year. A friendly reminder that CHFS annual open enrollment period for Oxford Health and Delta Dental plans effective date for eligible employees is 1/1/2017 thru 2/28/2017. During this period, you will be able to enrolled, add/remove dependent (s), and change health insurance plans. Please make an appointment with me as soon as possible, should you need to make adjustments or for any questions.
Therefore, CMC is experiencing an ALOS of 9.2 days with the statewide average being 6.4 days. Expenses per patient day are highest at CMC with an exception of 2 larger university medical centers. There is currently a Governing Board of 27 members and a Parenting Corporation of 19 members. Both boards lack diverse environment.
Membership Services (MSD) at Kaiser Permanente used to be a modest department of sixty staff. However, over the past few years the department has doubled in size, creating minor departmental reorganization. In addition the increase of departmental staffing, several challenges became apparent. The changes included primary job function, as well as the introduction of new network system software which slowed down the processes of other departments. These departments included Claims (who pay the bills for service providers outside of the Kaiser Permanente network), and Patient Business Services (who send invoices to members for services received within Kaiser Permanente). Due to the unforeseen challenges created by the system upgrade, it was decided that MSD would process the calls for both of the affected departments. Unfortunately, this created a catastrophic event of MSD receiving numerous phone calls from upset members—who had received bills a year after the service had been provided. The average Monday call volume had risen from 1,800 to 2,600 calls per day. The average handling time for each phone call had risen as well—from an acceptable standard of 5.6 minutes to an unfavorable 7.2 minutes. The department continued to be kept inundated with these types of calls for the two years that these changes have been effect.
Blue Cross Blue Shield of Florida (BCBSFL) Operating Services is Florida’s largest insurer, serving more than 6 million residents in total. Three trends that redefine how Blue Cross Blue Shield of Florida brings value to its members are through consumer empowerment, E-business, and financial services modernization. BCBSFL holds approximately 30% of the HMO market share in Florida, which is twice the share of its nearest competitor. BCBSFL offers a BlueComplements program filled with discounts and services that allow members to stay healthy. Theses advantages include Healthy Alternatives, Vision One, TruVision, Hearx, GlobalFit, SafeTech, and Walgreens Mail Order Pharmacy.
Your healthcare provider will discuss the options with you and will help you decide which procedure is best for you.
Gravie is a health insurance broker, helps individuals find, buy and manage health insurance in the market easily. It gathers information such as healthcare habits and helps the individuals sort through all the options and find the right health care policy. It checks if the individual is eligible for tax credits or/and money from employer. The service offered to the customer is free of cost, the revenue is generated through a commission it collects from insurance companies by selling policies and from the employer on per employee basis to provide the personalized customer service.
It is enthralling to note that in spite of the advances in healthcare systems, such as our hospital’s ability to provide patients with lower cost, managed One being the Health Maintenance Organizations (HMO), which was first proposed in the 1960s by Dr. Paul Elwood in the "Health Maintenance Strategy”. The HMO concept was created to decrease increasing health care costs and was set in law as the Health Maintenance Organization Act of 1973, after promotion from the Nixon Administration. HMO would, in exchange for a fee, allow members access to employed physicians and facilities. In return, the HMO received market access and could earn federal development funds.
When one examines managed health care and the hospitals that provide the care, a degree of variation is found in the treatment and care of their patients. This variation can be between hospitals or even between physicians within a health care network. For managed care companies the variation may be beneficial. This may provide them with opportunities to save money when it comes to paying for their policy holder’s care, however this large variation may also be detrimental to the insurance company. This would fall into the category of management of utilization, if hospitals and managed care organizations can control treatment utilization, they can control premium costs for both themselves and their customers (Rodwin 1996). If health care organizations can implement prevention as a way to warrant good health with their consumers, insurance companies can also illuminate unnecessary health care. These are just a few examples of how the health care industry can help benefit their patients, but that does not mean every issue involving physician over utilization or quality of care is erased because there is a management mechanism set in place.
The current state of affairs in the development of health policy in the United States is that it is constantly in flux and its implementation is disorganized and inefficient. As was the case with the recently passed Affordable Care Act legislation, political and lobbying interests often intersect in a manner that makes meaningful, most appropriate changes unlikely. The ACA kept in place the fractured nature of American health care and insurance, and appears to have benefited insurance companies by increasing enrollments rather than making the care provided better on a large scale. The majority of the plans on the created exchanges, up to 87%, are funded by federal subsidies (Blumenthal, Abrams, & Nuzum, 2015). These plans must cover individuals regardless of pre-existing conditions. The burden of the cost of insurance shifted to tax-payers and the young/healthy who are now overly burdened with mandatory coverage that they may or may not need in
Kaiser, L. R., A. C. O. Surgeons, and W. H. Pearce. Acs surgery, principles & practice. 6th. Webmd Prof Pub, 2007. eBook.
...ple less than or equal to 133% of the FPL, starting 2014 eligibility will be expanded to people that are 138% or les of the FPL. Also the expansion will cover more parents and expand to adults who are childless. Fore states that choose to accept the expansion this means that they will have to cover more individuals in their Medicaid programs. The government will provide 100% funding for the first 3 years of the Medicaid expansion; thereafter the states will have to figure out how they will fund the program with the absence of federal funding. The stipulation with expanding Medicaid that after the three years are up the state cannot modify the program to not cover the expanding individuals. States that in financial ruins before the ACA, now with the expansion they will need to find alternative ways that will serve the same purpose as Medicaid in order to lower cost.
Conditions of Participation was created to ensure all facilities participating in Medicare follow a set of regulations that protect the safety of Medicare recipients. In 1986 revisions were made to reinforce accreditation and certification procedures. Participating hospitals that are accredited by the Joint Commission on Accreditation of Healthcare Organizations or American Osteopathic Association have been deemed to meeting Conditions of Participation requirements on the wellbeing of Medicare Recipients. The Joint Commission on Accreditation of Healthcare Organizations also requires that the facilities are licensed by their state. (Lohr, 1990, p.
To improve services at the ABC Physician Practice Group, we decided to analyze appointment scheduling to increase patient access to the providers. This was achieved by measuring the Third Next Available appointment system using the following steps:
After treatment, patients should contact their doctors’ office immediately if they notice or experience the following:
The US healthcare system is focused on a mixed insurance system with both private and public insurance institution. The health insurance system also relies heavily on employment. It depends heavily on corporations and employees to be key sponsors for insurance. This has led to many companies going bust as they are unable to sustain the amount of funds required just to keep their employee’s insurance policies going. Insurance has become so profitable that there are more than a thousand private companies that want to share this very profitable business. These companies are also not regulated on a country level. The profit-targeting companies have also come up with many overlapping and unnecessary policies to fully utilize the loophole in the American healthcare system. These are all in addition to the public insurance policies such as Medicare: covers elders, disable and end stage renal diseases, and Medicaid: children, war veterans and self-employees. As of 2015, 15% of the population is without insurance; one of the major reason is due to the people not having sufficient knowledge on their eligibility.
"What Tests Might Be Ordered ." Penn Orthopaedics . N.p., n.d. Web. 26 Mar. 2014. .