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Health Maintenance Organization

You
have been presented an outstanding opportunity to serve as a graduate student
intern for the chief executive officer (CEO) of a large HCO. The HCO is an HMO
model and originated approximately a century ago as a small rural hospital. Due
to the rural setting, the HMO model flourished and, over the years, expanded
throughout the region. Today, the HMO has a presence in over eighteen counties
and has a number of competing interests from for-profit and not-for-profit HCOs
in the region.
The
board of directors recently approved the acquisition of two regional hospitals.
First, the HCO decided to acquire a small rural critical-care-access hospital
in a relatively remote county. The interest in acquiring the hospital is to
service the existing population and expand the reach of the HMO. Second, the
HCO decided to acquire a private full-service hospital in a moderate-size city
(population forty-two thousand). The HCO’s move is strategic in nature,
preventing the sale of the hospital to its for-profit competitor, and will gain
the region its sole emergency department level 2 (two) trauma center with
helicopter transport while giving the HCO the ability to service its growing
HMO membership in the area.
Based
on the above information:

Evaluate the various HMO models
(staff, group, and network) and identify the model that would probably be
best suited for the region. Justify your answer.
Research and comment on the
importance and applicability of the various levels of emergency department
trauma care. Investigate the exemptions afforded to a critical care rural
hospital with respect to Medicare reimbursement and accreditation.
Elaborate on the difference
between an HMO and an accountable care organization (ACO).
Explain the concept of
capitation, its importance to the HMO and participating providers, and how
the concept of capitation varies with the ACO model.
Explain patient-centered care
and its importance in healthcare delivery.

Submission Details:

Submit your answers in a 2- to
3-page Microsoft Word document.
REMEMBER: USE Peer Reviewed
Journals at our library. There is a requirement that you must only utilize
new researchwhich
is not older than 36 months
Health Maintenance Organization.docx

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