WGU C428 PA - Performance assessment 2024 Complete
2024
WISEMAN
[COMPANY NAME] | [Company address] lOMoARcPSD|5967629
C428- Financial Resource Management in
Healthcare A1.
Three fiscally sustainable strategies that will help Seamus Co. move away from a fee-service model to an MCO model, would be to transition to a HMO, PPO, or a HDHP.
•HMO (Health Maintenance Organization) provides coverage for plan network providers. Because there are contracts in place, premiums and total out-of-pocket cost are lower. In
an attempt to control cost, the patient must choose from the in-
network providers. Any out-of-network providers will not be covered.
•HDHP (High Deductible Health Plan) This plan is often chosen because of the low
monthly premium. But is popular for those who only want preventative care. With that in mind, any other care would be a full out-of-pocket cost until the deductible is met, so a high out-of-pocket would be the downfall of this plan. In most cases a Health Savings Account can be utilized with this plan to help with expenses out of pocket.
•PPO (Preferred Provider Organization) Unlike an HMO, PPO plans have the freedom to
choose your provider, while still getting a discount cost when using in-
network providers. With quality, comes cost. This plan is not always the most cost effective but will allow the patient the freedom of using it as they see fit as no preventative visits are required or encouraged, and they are allowed to choose their providers either in or out of network
A1a.
Cost saving measures: Cost savings will vary on the strategy chosen. PPO plans usually have the highest premiums and cost for employees and employers’ verses HMO and HDHP. This could result in fewer benefit enrollments but offers the best flexibility of provider selection. HDHP offers the lowest premiums for employees and
would be ideal for those whom are healthy and only want preventative care. But for those with families needing better coverage, HDHP would not be beneficial as out-
2024
WISEMAN
[COMPANY NAME] | [Company address] lOMoARcPSD|5967629
C428- Financial Resource Management in
Healthcare A1.
Three fiscally sustainable strategies that will help Seamus Co. move away from a fee-service model to an MCO model, would be to transition to a HMO, PPO, or a HDHP.
•HMO (Health Maintenance Organization) provides coverage for plan network providers. Because there are contracts in place, premiums and total out-of-pocket cost are lower. In
an attempt to control cost, the patient must choose from the in-
network providers. Any out-of-network providers will not be covered.
•HDHP (High Deductible Health Plan) This plan is often chosen because of the low
monthly premium. But is popular for those who only want preventative care. With that in mind, any other care would be a full out-of-pocket cost until the deductible is met, so a high out-of-pocket would be the downfall of this plan. In most cases a Health Savings Account can be utilized with this plan to help with expenses out of pocket.
•PPO (Preferred Provider Organization) Unlike an HMO, PPO plans have the freedom to
choose your provider, while still getting a discount cost when using in-
network providers. With quality, comes cost. This plan is not always the most cost effective but will allow the patient the freedom of using it as they see fit as no preventative visits are required or encouraged, and they are allowed to choose their providers either in or out of network
A1a.
Cost saving measures: Cost savings will vary on the strategy chosen. PPO plans usually have the highest premiums and cost for employees and employers’ verses HMO and HDHP. This could result in fewer benefit enrollments but offers the best flexibility of provider selection. HDHP offers the lowest premiums for employees and
would be ideal for those whom are healthy and only want preventative care. But for those with families needing better coverage, HDHP would not be beneficial as out-
