. As managed care has evolved, new delivery systems have been established. One s
ID: 431410 • Letter: #
Question
. As managed care has evolved, new delivery systems have been established. One such delivery
system is the Accountable Care Organization (ACO) . Describe the ACO its beginnings, overall
objectives, its structure and key features. Managed care companies are partnering with providers
to establish ACO’s. Discuss the positive or negative impact the ACO will have on reducing
health care costs while producing quality outcomes.
2. HMO’s improve health care. HMO’s do not improve health care. The debate goes on.
Discuss the tools and features HMO’s use to improve health care—give examples--
Take a position on this issue and explain your view.
3. The Consumer Directed Health Plan especially the Health Savings Account (HSA) product is
gaining popularity among purchasers of health care and managed care companies. Describe
the HSA its origins, structure and key features. What are the advantages or disadvantages
of the HSA. Take a position on this issue and explain your view.
Explanation / Answer
Firstly, let’s start with Accountable Care Organizations (ACO):
ACO, as a terminology, can be said as a cluster or a group of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated health care facilities of premium quality to the patients they serve.
ACO is like a health care organization that ties payments to quality metrics and the cost involved in that medi-care process.
ACO, thus helps in providing their patients, especially who are chronically ill, timely right care. ACO, as a model, helps the patients to enjoy freedom in selecting their choice of medical service providers, and thus places the financial responsibility on the providers in hopes of improving health care management and limiting unnecessary expenditures. By increasing care coordination, ACO’s were proposed to reduce unnecessary costs and improve facilities.
When an ACO is successful in delivering high quality care and spending health care dollars more wisely, it shares the savings incurred with the Medicare program.
To start with the beginning, ACO, as a term, was first used in 2006 by Elliot Fisher during a ‘Medicare Payment Advisory Commision’ discussion. It somewhat resembles the definition of Health Maintanience Organization (HMO), that emerged in the 70’s. Like and HMO, even ASO is held accountable for providing comprehensive medical servces to its population.
The objectives of ACO’s is:
Structure:
The Benefits of an ACO are:
The disadvantages are:
HMO (Health Maintanience Organization) is a medical insurance group that helps in providing health services for a fixed annual fee.
Now, because of all the above points, features, advantages and diadvantages regarding HMO’, I take a stand in the issue stating that there are many other better options than opting for an HMO.
First of all, because of the lawsuits and a negative name in the market, people will shy away from HMO, as health care issues is a sensitive sunject and a dear matter which cannot be ignored or taken lightly. Secondly, if there are better options, where costs incurred are less, with the same amount of success ratio, why would I hesitate to opt that option.
The structure of an HMO is in such a way that sometimes, though on purpose or not, the relative costs are increased. SO why not, in such a bill, opt for some other premium health facility.
Now, talking about Health Savings Account (HSA), it is a tax-advantaged medical savings account available to taxpayers only in the United States, who are enrolled in a high-deductible health plan.
The funds in such account are not subject to federal income tax at the time of deposit. Unlike a flexible spending account, HSA funds roll over and accumulate year on year if they are not spent.
HSAs are owned by the individual, which differentiates them from company-owned Health Reimbursement Arrangements (HRA), that are an alternate tax-deductible source of funds.
HSA funds may be used to pay for qualified medical expenses at any time, without federal tax liability or penalty.
To talk about the Origin of HSA's, they were were established as part of the Medicare Prescription Drug, Improvement, and Modernization Act, signed into law by President George W. Bush on December 8, 2003. They were developed to replace the medical savings account system.
To Salient features and the structures of an HAS are not so complexed:
Now, there are many advantages and disadvantages of an HAS:
Following are the drawbacks:
My take on this view, after checking out both, the advantages as well as the drawbacks, is that Has Can be a better option for the average and above average income group, rather than for the below average group.
Market risk is not something which the people below the average income group can adhere too.
Savings is a must for them, and there are other options for them than this.
Thus, according to me, HSA has a better chance for the better income group.
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