University of Phoenix Healthcare Models Discussion Question

Expert Solution Preview

Introduction:
The purpose of this assignment is to evaluate the framework and various dimensions of access to care, including delivery, and quality among the health care models. The two health care models that will be discussed are PPO and Medicaid. This assignment will delve into the qualifications, quality monitoring, reimbursement for health care providers, emphasis on prevention and wellness, and primary drivers of health care financing associated with each of the plans. Additionally, this assignment will identify the most significant factor requiring reform to finance a health care system that covers all or most of the population.

Answer:
Quality monitoring in PPO healthcare plan is done through quality measures such as Healthcare Effectiveness Data Information Set (HEDIS), Quality Compass, and the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. On the other hand, quality monitoring in the Medicaid healthcare plan is done through the use of Access and Availability Standards (AAS), Child and Adult Core Sets, and Healthcare Effectiveness Data Information Set (HEDIS). Both healthcare plans emphasize meeting the standards set by these measures.

The primary qualifications for PPO healthcare plan include being employed, self-employed, or having a small business. The plan is also available to individuals under the Affordable Care Act. Medicaid healthcare plan qualifications vary depending on the state, but it is primarily offered to people with low-income levels, pregnant women, children, and people with disabilities.

PPO healthcare plan reimburses health care providers through a fee-for-service model. In contrast, Medicaid healthcare plan reimburses providers through managed care organizations (MCO) or fee-for-service models. Additionally, both plans reimburse providers for telehealth services.

Prevention and wellness receive more emphases in Medicaid healthcare plan than the PPO healthcare plan. Medicaid healthcare plan has wellness programs that provide beneficiaries with access to healthy food, physical activity options, and resources to quit smoking. In contrast, PPO healthcare plan offers wellness programs but not to the extent of Medicaid.

Primary drivers of health care financing include insurance premiums, taxes, out-of-pocket costs, and government funding. In the United States, the government funds programs like Medicaid and Medicare. Additionally, individuals purchase insurance plans from private insurance companies, and they pay out-of-pocket costs.

The component that requires the most reform in financing a healthcare system that covers all or most people is the high cost of healthcare. The United States healthcare system is expensive, and the high costs make it inaccessible to many people. Private insurance providers charge high premiums; therefore, there is a need for the government to regulate insurance providers to make healthcare affordable for everyone.

Conclusion:
In conclusion, the PPO and Medicaid health care models differ in quality monitoring, qualifications, reimbursement for health care providers, emphasis on prevention and wellness, and primary drivers of health care financing. The high cost of healthcare is the primary component that requires reform to finance a healthcare system that covers all or most people.