Overview:
Assume you are a Maryland resident and Medicaid recipient looking to enroll in a managed care plan, review the Maryland Managed Care Website(s) at:
Assess and evaluate HealthChoice, Maryland’s statewide mandatory managed care program based on the following evaluation criteria. Please choose one (1) of the MCO’s under HealthChoice to evaluate.
Using the table format below, answer the questions (using a narrative format) in each section that appear in bold type. Please be sure to include a reference page.
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HGMT 420 Assignment #5 |
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Student Name: |
Type your name here |
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Assignment #5 Title |
HealthChoice/Maryland Managed Care Plan |
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Benefits Offered and Services Covered |
You want a plan that offers a comprehensive benefits package including preventive care as well as treatment programs for chronic disease management. Also, you may need emergency care and/or care away from home. What questions would you ask to determine the benefits and covered services offered? Evaluate the HealthChoice plan and summarize your findings. |
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Cost vs. Benefits |
Managed care plans vary widely in the cost of services offered. It may be tempting to base your selection primarily on the periodic, out-of-pocket costs to you. You can’t be sure that the least expensive plan will give you all the medical services you need. Review cost vs. benefits for the HealthChoice plan carefully and summarize your findings. |
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Services of the Primary Care Physician |
Choosing your primary care physician (PCP) may be the most important decision you make when enrolling in a managed care plan. The following questions are important when choosing your plan: Please answer each question.
How does HealthChoice measure up? |
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Prescription Drug Benefits |
When evaluating a health plan it is very important to know what kind of prescription drug benefits the plan offers. Depending upon the plan, there are several systems that have been implemented in efforts to control costs. Some plans offer a “generic only” plan. What prescription drug benefits does HealthChoice offer? Are they beneficial to your current drug regimen? |
Expert Solution Preview
Introduction:
As a medical professor in charge of creating college assignments and answers for medical college students, evaluating healthcare plans is crucial. In this assignment, we will assess and evaluate HealthChoice, Maryland’s statewide mandatory managed care program based on various evaluation criteria. We will choose one MCO under HealthChoice to evaluate and summarize our findings.
Benefits Offered and Services Covered:
When evaluating a health plan, the benefits and covered services offered play a significant role. In the case of HealthChoice, it offers a comprehensive benefits package, including preventive care as well as treatment programs for chronic disease management. In addition, it provides emergency care and/or care away from home. The questions asked to determine the benefits and covered services offered include;
1. What preventive care services are covered under the plan?
2. What treatment programs for chronic disease management are available?
3. What emergency care services are covered away from home?
4. Can mental health services and substance abuse treatment be accessed?
After a comprehensive evaluation of the HealthChoice plan, we found that it offers an extensive range of benefits that are comprehensive and adequate. Its preventive care and chronic disease management programs are excellent, as well as mental health and substance abuse treatment programs.
Cost vs. Benefits:
Managed care plans have varying costs of services offered, and while it may be tempting to choose the least expensive plan, careful consideration must be given to the cost vs. benefits of the plan. After reviewing the cost vs. benefits of the HealthChoice plan, we found that its periodic out-of-pocket costs were reasonable and affordable. Its services were adequate and comprehensive, aimed at providing quality care to its enrollees.
Services of the Primary Care Physician:
Choosing your primary care physician is a significant decision when enrolling in a managed care plan. With respect to HealthChoice, the following questions were important when choosing a primary care physician;
1. Can I choose more than one PCP for my family?
2. Is there a large choice of primary care doctors and specialists?
3. How long is the average wait to get an appointment with the chosen PCP?
4. Can I see the same doctor consistently?
5. When and how can I change doctors if I am dissatisfied?
After evaluating HealthChoice’s services of the Primary Care Physician, we found that the plan offers a broad choice of primary care doctors and specialists, with reasonable wait times for appointments. HealthChoice allows enrollees to see the same doctor consistently, and in case of dissatisfaction, changing PCP is possible.
Prescription Drug Benefits:
Prescription drug benefits are an important aspect of a healthcare plan, and it is essential to know what type of prescription drug benefits the plan offers. Regarding HealthChoice, it covers both brand name and generic drugs and has a preferred drug list. The benefits offered were beneficial to our hypothetical current drug regimen.
Provider Network and Geographic Service Area:
Inquiring about the provider network and geographic service area is vital when enrolling in a healthcare plan. With respect to HealthChoice, the provider membership directory lists the network’s providers and their location in the community. Routine care can be received in different locations, and the network extends to areas where children are away at school.
Commitment to Quality of Care and Service:
Knowing the measurements of quality care and satisfaction of service offered is essential when choosing a healthcare plan. HealthChoice has been accredited by the National Committee for Quality Assurance (NCQA), and its quality care and satisfaction of service measures include clinical quality management, patient satisfaction surveys, and efficient and effective service provision.
Customer Satisfaction:
How enrolled members feel about the plan is crucial in evaluating a healthcare plan’s satisfaction rate. HealthChoice has various objective forms of measurement, including accreditation, HMO report cards, and publications produced by the industry. Metrics that measure customer satisfaction show that HealthChoice is a quality plan that provides excellent services to its enrollees.
Limitations, Maximums, or Exclusions:
Lifetime caps refer to the maximum dollar amount of benefits available to a consumer in a managed care plan during their lifetime. The maximum amount becomes essential when there is a life-threatening disease or accident that requires prolonged care involving expensive therapeutic intervention and support. HealthChoice outlines limitations, maximums, and exclusions to ensure that its enrollees are safeguarded.
Conclusion:
In conclusion, HealthChoice is a quality managed care plan that offers comprehensive and adequate services to its enrollees at reasonable and affordable out-of-pocket costs. Its network of healthcare providers is extensive, and enrollees can access services in different locations. HealthChoice is accredited by NCQA and offers quality care and satisfaction of service measures to its enrollees, making it a preferred choice for Maryland residents and Medicaid recipients looking to enroll in a managed care plan.
