Determine the key characteristics of the users of the products and/or services of the health care provider you selected.
Some of the main characteristics of Blue Cross and Blue Shield are long-term, short-term commitment; providing support, learning and development in health care organization. The key services that the majority of Blue Cross and Blue Shield customers use are the following: prescription assistance, hospital admission, emergency medical evacuation, medical repatriation, and medical monitoring. These are all key services that show how Blue Cross and Blue Shield provide support for their customers. Blue Cross and Blue Shield health insurance coverage characteristics will vary depending on the type of health care coverage you have. Coverage for the HMO plans is different from the PPO plans. Therefore, some things that are covered in one may not be covered in the next. “Some of the personal characteristics of users are age, gender/sex, race, income and socioeconomic status, education, availability of care, culture and patients beliefs”.(Kotler, Shalowitz, Stevens)
HMO plans usually have lower up-front costs on most premiums, than any other type of premiums. The HMO plans usually have lower deductibles or no deductible at all. A deductible is the amount of money you pay out-of-pocket before your plan will pay on your doctor visits or other medical services. People also have deductibles to pay on their medicines and other services that are provide by health care providers. People that have the HMOs plans also pay low copayments on medical services. Most people have copayments that are due at the time of service. These are set amounts that you pay for the service that the insurance did not pay for. An example of a copayme...
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...orking, and word of mouth are important to insurance companies. With Blue Cross and Blue Shield they send their agents to training where they can learn how to target their customers and they learn where their profitable niche markets are. Not only do Blue Cross and Blue Shield train in what interest their customer; but they train to learn what each policy is all about. This helps the customer trust the insurance company more.
Blue Cross and Blue Shield give its customers good prices on policies and good quality. This is why they are among the top insurance companies that offers their services in different states; but offers the same good quality and great prices.
REFERENCE
https://bcbsal.org/web/
Health Benefits Plan; BlueCross BlueShield of Alabama; revised 2012.
Strategic Marketing for Health Care Organizations: 2008, Kotler, Shalowitz,Stevens
According to the State Farm website, the company handles nearly 35,000 claims per day. They still use Mercherle’s original vision which is to operate fairly and do the right thing for their customers. By continuing with this vision, State Farm now offers nearly 100 products and services. It is currently ranked number 41 on the Fortune 500 list of largest companies. This company not only focuses on being there for their customers but they are also involved and support communities through “sponsorships, safety programs, education leadership, and service-learning”. Their mission is to be a good neighbor for customers and communities by building a foundation of shared values.
While there are not too many insurance companies in Canada, this gives RBC a competitive advantage, as they are able to customize packages for an individual for example, something that is competitive with the market. Because there is a lower supply of insurance companies, the supplier bargaining power is high in this case. RBC has as extensive portfolio for insurance types ranging from travel, auto, contents, home, life and disability insurance; furthermore strengthening their competitive advantages compared to other insurance companies who may not offer the same insurance types, or at a special premium. Another example that demonstrates RBC’s high bargaining powers is its ability to cross or up sell other packages to meet the needs of existing customers when it uses its customer service or call centre, as mentioned in the
The strategic plan for 2015 led to a membership growth of 650,000 members. The main internal driver for the astounding growth, being managed care offered at 20% to 25% less than the surrounding competitors (Brooking Institution, 2015). The more membership growth the more profitable Kaiser becomes based managed care system. Kaiser Permanente’s growth can be related to high scores amongst CMS and it’s highly recommended operation structure amongst the healthcare industry. According to the CMS “2016 Star Ratings Fact Sheet,” Kaiser Permanente represents five of 12 medicare health plans (with Parts C and D) that earned 5 stars — and of the 1.6 million beneficiaries enrolled in those 5-star plans nationwide, 81 percent are Kaiser Permanente Medicare members (Kaiser press release). The Kaiser Permanente Medicare plans since 2009 have always been operating at a high performance
Health Maintenance Organization (HMO) is a group of individual health plans that are intended to provide services for costumers’ that purchase insurance policies and for those that cannot afford health insurance. Many of these organization are led by physicians, and other professionals that network together to make health care affordable for patients. In the HMO category there are five separate managed care plan models. First, the Group Model (HMO), is a group that has a number of physicians that mainly agree to provide care to a defined group of patients in return for a fix rate capita payment for discounted fees from insurance companies (Henderson, 2012 p.212).
HMOs are wellness-focused: they cover almost all preventive exams, their premiums are generally far lower, and your doctor will likely be chosen for you. PPOs, on the other hand, allow you to choose doctors from a PPO network; they do cost more; but on the other hand, they are more focused on treating and covering you when things go wrong, if that makes sense. So if you want to keep costs down and are very healthy, an HMO is your best bet. If you want to be sure your coverage is as high as possible no matter what the contingency, and are willing to pay more for it, a PPO is the right choice for
Health Maintenance Organizations, or HMO’s, are a very important part of the American health care system. Also referred to as managed care programs, HMO's are combinations of doctors and insurance companies that are formed into one organization. This organization provides treatment to its members at fixed costs and decides on what treatment, if any, will be given based on the patient's or doctor's current health plan. Sometimes, no treatment is given at all. HMO's main concerns are to control costs and supposedly provide the best possible treatment to their patients. But it seems to the naked eye that instead their main goal is to get more people enrolled so that they can maintain or raise current premiums paid by consumers using their service. For HMO's, profit comes first- not patients' lives.
Managed care plans present as forms of health insurance covers. These plans have contracts with medical facilities and health care providers to offer care for clients at decreased costs (Dixon, Greene & Hibbard, 2008). This paper will discuss the criticisms that have been addressed regarding managed care, and the different features that are included in a CDHP. Additionally, it will discuss the existing differences between the choice of providers, cost sharing, and covered benefits of HMOs and CDHPs. This will help in drawing conclusions regarding the latest information that surrounds managed care.
3. Preferred Provider Organization (PPO) - It is a most popular plan. It 's similar to an HMO, but you cover medical care after it 's received as opposed to paying a monthly monetary fee. You also have the opportunity of seeing out-of-network physicians. Visits within the network require a small fee, while out-of-network visits may need a deductible payment in addition to a co-payment.
Other companies pay for all insurance claims needed by the employee and only have them pay
However, the reason a lot of these insurance companies are not popular among the general public is because they are new to the insurance game and are often unable to handle processing claims that have become second nature to the giants of the insurance industry. Opponents could also claim the ACA’s out of pocket maximum helps people not get drowned in debt. Sure, maybe the individuals themselves aren’t directly in debt and being spammed with outrageous hospital bills. However, the part of their bills that count toward their out of pocket maximum are sometimes unclear. “Even though things are a lot simpler now, depending on your plan not all services are going to be covered 100% and not all services are always going to count toward your out-of-pocket maximum. Double check that your health plan isn’t cutting any of the corners” (Out-of-Pocket) Opponents may also say that the ACA lowers premiums, but that 2008 statement has become increasingly known as a lie. Obama spent 2008 telling the American people throughout his campaign insurance would be reduced “up to”, “on average”, and “typically” $2,500 “per family, per year”. That turned out to be false and “by some estimates, the average rates in the individual market have increased nearly 25 percent compared to what they would have been without Obamacare, and have increased measurably in 45
The three main types of health insurance in the United States are voluntary, social and welfare. These types on insurance a person possess sometimes determine the ability to seek care and how that care is given. Insurance types such as voluntary and social insurance can be very expensive and will make participants consider how important it is for them to see the doctor, while welfare medicine participants have trouble finding a doctor due to the limit number of physicians who are provider or are refusing to take on new patients. Some of the types of voluntary insurance are Blue Cross and Blue Shield (BCBS), private and commercial insurance, and health maintenance organizations. Voluntary insurance is not only limited to health care from physicians, but can also include dental, long-term, and life insurance. One of the most popular voluntary insurance companies is BCBS. Sometime people have trouble paying for insurance especially if is as it related to an on the job injury or because they have reached retirement age and can no longer work.
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. An HMO is a integrated delivery system that combines both the delivery and financial aspects of health care for consumers. Under the HMO, each patient is appointed to a primary care physician (PCP), who is essentially accountable for the long-term care of the members that she/he has been assigned and any specialists that a patient needs to see should be referred by their PCP. Some examples of HMOs are Kaiser Permanente and Humana. HMOs are licensed at the state level, under a license that is known as a certificate of authority. A pro of an HMO is that treatment for a patient can begin prior to their insurance being authorized; A member may benefit from this because there would be little to no treatment delays. A con of an HMO is that in order to save cost, most HMOs provide narrow provider networks; A member may not benefit if in an emergency because their “in-network” emergency room might be far or there are “quick-care” in their
Managed care dominates health care in the United States. It is any health care delivery system that combines the functions of health insurance and the actual delivery of care, where costs and utilization of services are controlled by methods such as gatekeeping, case management, and utilization review. Different types of managed care plans came into development by three major factors. These factors include choice of providers, different ways of arranging the delivery of services, and payment and risk sharing. Types of managed care organizations include Health Maintenance Organizations (HMOs) which consist of five common models that differ according to how the HMO is related to the participating physicians, Preferred Provider Organizations (PPOs), Exclusive Provider Organizations (EPO), and Point of Service Plans (POS). `The information management system in a managed care organization is determined by the structure of the organization' (Peden,1998, p.90). The goal of a managed care system is to provide subscribers and dependants with needed health care services at the lowest possible cost. Certain managed care plans also focus on prevention by trying to keep members healthy.
Health insurance is available from several sources. Private health insurance is provided by private companies. Subscribers pay health insurance companies a monthly fee for health insurance. In return, the company agrees to pay the doctor and hospital costs if the subscriber gets sick. There are different levels of coverage that a subscriber can purchase, but the cost of a health insurance policy is also set by the amount of risk the subscriber is willing to take. The more expense the subscriber is willing to pay, as either deductible or co-payment, the less the insurance company will charge for the insurance. Some Americans purchase their own health insurance, but most employers pay for the health insurance of its workers. Often this insurance
Health insurance provides benefits for sickness, injury, surgery, and prescription medication. There are a variety of plans with different