Please respond to the following:
Compare and contrast primary available economic resources that health insurance payers may use to monitor, assess, and regulate health care providers’ behavior. Evaluate the degree to which alternative provider payment methods (e.g., capitation, pay for performance, etc.) impact HMO economic and business performance. Provide one example of such a type of method to support your response.
Be sure to respond to at least one of your classmates’ posts.
Also respond to my classmate’s post below:
Beryl Hudson
RE: Week 4 Discussion
Hello Dr. Levesque and classmates,
Compare and contrast primary available economic resources that health insurance payers may use to monitor, assess, and regulate health care providers’ behavior. Evaluate the degree to which alternative provider payment methods (e.g., capitation, pay for performance, etc.) impact HMO economic and business performance. Provide one example of such a type of method to support your response.
Principle-agent relationships happen when there is an individual or an entity, which is referred to as the agent, and this agent act on behalf of another individual or principle entity. The provider (provider payment) acts as an agent for the two individual principals-the patient and the insurer. Provider payments happen when a certain amount is allocated to a healthcare provider to pay for specific items necessary to the patient well being. These items could include building costs, employees, medicines, and any other necessary supplies. Provider payments will also include any profits that are made. All of these costs are to the insurers are paid for by the premiums that are paid by the consumers/patients.
The degree to which alternative provider payment methods impact HMOs and business performances have changed over the years. Health insurance coverages started in the early 1900s, and since then more than 70 years have passed. Now, there are more insurance programs in the healthcare industry, and there are numerous types of healthcare offered to individuals. In addition, the healthcare industry has grown to the point that there are many more medical specialties. Currently, one of the main issues challenging managed healthcare facilities is making sure that they meet/exceed important regulatory requirements. There are specific ways that both the healthcare industry and patient expectations need to be met.
We know that the services provided by HMOs incorporate both quality and quantity, and this is determined by the healthcare provider themselves, and with whom the HMO contracted. The HMOs depend on the healthcare providers to supply them with specific information regarding the patient, and also require that the provider offer a level of care to the patient. This will speak to the provider supply under managed care.