HGMT 420 Assignment #5

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Assignment #5 Title

HealthChoice/Maryland Managed Care Plan

Benefits Offered and Services Covered

You want a plan that offers acomprehensive benefits package including preventive care as well astreatment programs for chronic disease management. Also, you may needemergency care and/or care away from home. What questions wouldyou ask to determine the benefits and covered services offered? Evaluatethe HealthChoice plan and summarize your findings.

Cost vs. Benefits

Managed care plans vary widely inthe cost of services offered. It may be tempting to base your selectionprimarily on the periodic, out-of-pocket costs to you. You can’t be surethat the least expensive plan will give you all the medical servicesyou need. Review cost vs. benefits for the HealthChoice plan carefully and summarize your findings.

Services of the Primary Care Physician

Choosing your primary carephysician (PCP) may be the most important decision you make whenenrolling in a managed care plan. The following questions are importantwhen choosing your plan: Please answer each question.

• Can you choose more than one PCP for your family?
• Is there a large choice of primary care doctors and specialists?
• How long is the average wait to get an appointment with the chosen PCP?
• Can you see the same doctor consistently?
• When and how can you change doctors if you are dissatisfied

How does HealthChoice measure up?

Prescription Drug Benefits

When evaluating a health plan itis very important to know what kind of prescription drug benefits theplan offers. Depending upon the plan, there are several systems thathave 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?

Provider Network and Geographic Service Area

Be sure you inquire from theProvider Membership Directory which providers are included in thenetwork and where they are located in your community. If youlive in one community and work in another; determine if routine care canbe received in either location. Does HealthChoice have a strong networkof Providers in a geographic area that is amenable to you? Must you goto different locations for different services? If you have a child awayat school, does the network extend to that area?

Commitment to Quality of Care and Service

What measures of quality care and satisfaction of service are available? Itis worthwhile to find out if the plan has been accredited by theNational Committee for Quality Assurance (NCQA). NCQA is the most commonaccrediting body for network plans. Review and report on what measures of quality care and satisfaction are available for HealthChoice.

Customer Satisfaction

How do enrolled members feel about the plan? Thereare various objective forms of measurement used to determine “qualityservices” given by managed care plans such as accreditation, HMO reportcards and/or publications produced by the industry. You would be wise tolook at any that measure customer satisfaction. The National Committeefor Quality Assurance (NCQA) mission is to provide information thatenables purchasers and consumers of managed health care to compare plansbased on quality. Their web site may be reached at http://www.ncqa.org/

Limitations, Maximums, or Exclusions

Lifetime Cap refers to the maximumdollar amount of benefits available to a consumer in a managed careplan during his or her lifetime. This amount becomes important whenconfronted with a life-threatening disease or accident that requiresprolonged care involving expensive therapeutic intervention and support.Does HealthChoice outline limitations, maximums, or exclusions?