Discuss how PPOs differ from HMOs. Support your comparison using references or real-life examples.
Discuss how nursing care facilities can enhance a patient’s quality of life. Support your discussion with references or real-life examples.
Write your reflections from the classmate’s post by selecting an idea from the reading, describing your thoughts and feelings about it and why you agree.
Question A: Managed care is a method of delivering health care in which a single entity manages finance, insurance, delivery, and payment. Health maintenance organization (HMO), Preferred Provider Organization (PPO), and Point of Service (POS) are three types of managed care in the market. The emphasis, intention, and audience of all these categories differ from the others. HMO emphasizes health care offering medical treatment for those in need as well as many other services to assist individuals to maintain their health. In reaction to the expansion of HMO plans, PPO plans are being introduced. To get coverage within an HMO, the individuals must stay within the network of providers whereas in the PPO plan individuals can have access to the network and out of the network of providers. According to Shi (2015), HMO has providers on staff as well as contracted. In the case of PPO, providers are contracted. HMOs need referrals for specialty treatments, but PPOs allow patients to access them without restriction. As mentioned by Managed Care outlook (2013), HMOs create networks of providers (doctors, hospitals, specialists, etc.) from whom members may select to receive treatment. While less flexible, HMOs tend to be less expensive with fewer out-of-pocket costs. PPO programs allow customers greater control over their health insurance coverage and treatment quality. HMO is preferred by most due to low monthly and out-of-pocket costs even though it doesn’t cover all the areas and treatments.
Question B: Nursing homes adopt a patient-centered care model to increase patient satisfaction. As an outcome, patients and their families are valued and appreciated throughout their healthcare journey. As mentioned by Shi (2015), certifications and licenses are generally needed for nursing care institutions. Non-compliance may reduce the quality of patient treatment resulting in fines and closures. So, these facilities support such as help prioritize what matters most to patients and families, plans for symptom management, care coordination, and additional homecare or assistive devices to compensate for functional losses (Toles et. al., 2021). Routine sterility and cleanliness practices, politeness and respect, and an act of trust that a skilled nursing caretaker retains towards patients play a significant role in raising the standard of living. According to Toles et al. (2021), nursing care facilities have reduced the mortality of patients recovering from serious illnesses. The sole goal of nursing care centers is to optimize adherence to treatment following primary care from hospitals.
Changing Landscape of Health Insurance Coverage Could Have a Significant Impact on HMOs. (2013). Managed Care Outlook, 26(5), 9–11.
Shi, L. (2015). Essentials of the U.S. Health Care System (4th Edition). Jones & Bartlett
Toles, M., Colón-Emeric, C., Hanson, L. C., Naylor, M., Weinberger, M., Covington, J., & Preisser, J. S. (2021). Transitional care from skilled nursing facilities to home: study protocol for a stepped wedge cluster randomized trial. Trials, 22(1), 1–15. https://doi.org/10.1186/s13063-021-05068-0