WGU D513: Healthcare Financial Management Task 2
|Latest Update with Complete Solution
KC
Student ID # XXXXXX
D513: Healthcare Financial Management
Task 2: Financial Management
A:..Summary
Corazon..y..Alma..Health..(CAH)..is..a..nonprofit..healthcare..provider..that..offers..a..full..range..o
f..services..to..the..community..in..Miami-
Dade..County,..Florida,..including..obstetrics;..however,..there..is..no..dedicated..OB..residency..progr
am,..there..are..access..to..care..issues,..the..hospital..has..a..high..C-
..section..rate..at..48.6%,..and..a..preterm..birth..rate..of..17.8%..(Western..Governors..University,..n.d.
c)...In..contrast,..the..national..average..for..C-
section..births..in..2022..was..32.1%..(March..of..Dimes,..n.d.b),..and..the..national..average..for..preter
m..births..in..2022..was..10.4%..(March..of..Dimes,..n.d.a)...The..target..population—
women..in..need..of..obstetrical..care—
is..at..risk..of..inadequate..care..throughout..their..pregnancies,..potentially..increasing..the..rate..of..co
mplications..for..both..the..mom..and..baby.
In..addition..to..the..challenges..that..CAH..is..experiencing..in..providing..quality..comprehensiv
e..OB..care,..the..risk..assessment..has..shown..barriers..to..care..that..include..significant..social..deter
1
,minants..of..health,..including..cultural,..financial,..educational,..and..geographic...Miami-
Dade..County..has..a..large..Hispanic/Latino..population..at..69.1%,..with..75.1%..of..the..population..s
peaking..a..language..at..home..other..than..English..(United..States..Census..Bureau,..n.d.)...As..a..mi
nority..population..with..a..potential..language..barrier,..the..Hispanic/Latino..women..may..feel..cult
urally..overwhelmed..in..seeking..healthcare,..or..may..not..understand..how..to..navigate..the..system
.
Financially,..uninsured..individuals..are..33%..of..the..population..(Western..Governors..University,..n.
d.c)..and..14.5%..are..living..in..poverty..(United..States..Census..Bureau,..n.d.);..lack..of..financial..res
ources..presents..significant..barriers..to..seeking..healthcare...In..the..county,..17.3%..of..the..populati
on..has..not..completed..high..school..(United..States..Census..Bureau,..n.d.),..which..may..contribute..t
o..lack..of..understanding..in..seeking..healthcare..and..making..informed..decisions.
Additionally,..there..may..be..issues..with..limited..or..no..transportation..living..in..a..climate..with..hot
..and..humid..summers..and..an..annual..rainfall..of..59”..that..far..exceeds..the..national..average..of..3
8”
(Best..Places,..n.d.),..all..of..which..can..deter..patients..from..braving..the..elements..to..take..public..tran
sportation..to..seek. . routine..prenatal..care.
In..moving..forward..with..the..implementation..of..a..formal..full-
service..OB..program..that..addresses..the..population’s..barriers..to..care,..CAH..will..be..better..positi
oned..to..provide..quality..care..that..will..reduce..complications,..including..C-
sections..and..preterm..deliveries,..thereby..improving..the..health..of..both..moms..and..babies...Redu
cing..complications..will..also..reduce..the..costs..associated..with..higher..levels..of..care..that..may..h
ave..been..avoided..with..routine..preventative..prenatal..care.
B:..Payment..Model
2
, The..payment..model..that..I..would..recommend..for..Corazon..y..Alma..Health..(CAH)..is..an..epi
sode-of-
care..model...In..this..reimbursement..model,..a..single..price..is..paid..for..an..entire..episode..of..care..(
Miller,..2009).. . This..payment..will..cover..all..of..the..patient’s..needed..services..and..it..is..up..to..the..
provider..to..determine..what..is..required..to..provide..optimal..quality..care...Adjustments..may..be..m
ade..for..complex..patients..with..a..higher..acuity..(such..as..a..high-
risk..pregnancy)..that..may..require..more..resources.
This..payment..model..is..best..for..patients..that..may..present..with..a..high..variation..in..the..cost..
of..the..episode,..but..without..concern..for..the..frequency..of..the..episodes..(Miller,..2009)...This..is..i
deally..suited..for..the..pregnant..patient..who..may..experience..a..routine,..uncomplicated..course..of..
prenatal..care,..labor..and..delivery,..or..there..may..be..a..variation..in..costs..due..to..complications..th
at..require..treatment..and/or..result..in..a..C-
section..or..preterm..delivery..(or..both);..the..frequency..of..the..episodes..will..vary,..but..are..certainly.
.lower..than..for..a..chronically..ill..patient..with..frequent..exacerbations..and..episodes..that..include..
hospitalizations..throughout..the..year.
Also..supportive..of..the..OB..patient..is..that..in..this..model,..the..physician..has..the..flexibility..to
..order..services..without..the..restrictions..of..prior..authorization..that..other..models..may..require..(
Miller,..2009)...This..allows..the..physician..to..provide..time-
sensitive..care..and..services..when..they..are..needed..and..allows..the..provider..to..closely..monitor..t
he..pregnancy..and..proactively..treat..any..potential..complications..that..are..diagnosed..before..they
..result..in..a..negative..outcome.
C1:..Pro..Forma..Budget
3
|Latest Update with Complete Solution
KC
Student ID # XXXXXX
D513: Healthcare Financial Management
Task 2: Financial Management
A:..Summary
Corazon..y..Alma..Health..(CAH)..is..a..nonprofit..healthcare..provider..that..offers..a..full..range..o
f..services..to..the..community..in..Miami-
Dade..County,..Florida,..including..obstetrics;..however,..there..is..no..dedicated..OB..residency..progr
am,..there..are..access..to..care..issues,..the..hospital..has..a..high..C-
..section..rate..at..48.6%,..and..a..preterm..birth..rate..of..17.8%..(Western..Governors..University,..n.d.
c)...In..contrast,..the..national..average..for..C-
section..births..in..2022..was..32.1%..(March..of..Dimes,..n.d.b),..and..the..national..average..for..preter
m..births..in..2022..was..10.4%..(March..of..Dimes,..n.d.a)...The..target..population—
women..in..need..of..obstetrical..care—
is..at..risk..of..inadequate..care..throughout..their..pregnancies,..potentially..increasing..the..rate..of..co
mplications..for..both..the..mom..and..baby.
In..addition..to..the..challenges..that..CAH..is..experiencing..in..providing..quality..comprehensiv
e..OB..care,..the..risk..assessment..has..shown..barriers..to..care..that..include..significant..social..deter
1
,minants..of..health,..including..cultural,..financial,..educational,..and..geographic...Miami-
Dade..County..has..a..large..Hispanic/Latino..population..at..69.1%,..with..75.1%..of..the..population..s
peaking..a..language..at..home..other..than..English..(United..States..Census..Bureau,..n.d.)...As..a..mi
nority..population..with..a..potential..language..barrier,..the..Hispanic/Latino..women..may..feel..cult
urally..overwhelmed..in..seeking..healthcare,..or..may..not..understand..how..to..navigate..the..system
.
Financially,..uninsured..individuals..are..33%..of..the..population..(Western..Governors..University,..n.
d.c)..and..14.5%..are..living..in..poverty..(United..States..Census..Bureau,..n.d.);..lack..of..financial..res
ources..presents..significant..barriers..to..seeking..healthcare...In..the..county,..17.3%..of..the..populati
on..has..not..completed..high..school..(United..States..Census..Bureau,..n.d.),..which..may..contribute..t
o..lack..of..understanding..in..seeking..healthcare..and..making..informed..decisions.
Additionally,..there..may..be..issues..with..limited..or..no..transportation..living..in..a..climate..with..hot
..and..humid..summers..and..an..annual..rainfall..of..59”..that..far..exceeds..the..national..average..of..3
8”
(Best..Places,..n.d.),..all..of..which..can..deter..patients..from..braving..the..elements..to..take..public..tran
sportation..to..seek. . routine..prenatal..care.
In..moving..forward..with..the..implementation..of..a..formal..full-
service..OB..program..that..addresses..the..population’s..barriers..to..care,..CAH..will..be..better..positi
oned..to..provide..quality..care..that..will..reduce..complications,..including..C-
sections..and..preterm..deliveries,..thereby..improving..the..health..of..both..moms..and..babies...Redu
cing..complications..will..also..reduce..the..costs..associated..with..higher..levels..of..care..that..may..h
ave..been..avoided..with..routine..preventative..prenatal..care.
B:..Payment..Model
2
, The..payment..model..that..I..would..recommend..for..Corazon..y..Alma..Health..(CAH)..is..an..epi
sode-of-
care..model...In..this..reimbursement..model,..a..single..price..is..paid..for..an..entire..episode..of..care..(
Miller,..2009).. . This..payment..will..cover..all..of..the..patient’s..needed..services..and..it..is..up..to..the..
provider..to..determine..what..is..required..to..provide..optimal..quality..care...Adjustments..may..be..m
ade..for..complex..patients..with..a..higher..acuity..(such..as..a..high-
risk..pregnancy)..that..may..require..more..resources.
This..payment..model..is..best..for..patients..that..may..present..with..a..high..variation..in..the..cost..
of..the..episode,..but..without..concern..for..the..frequency..of..the..episodes..(Miller,..2009)...This..is..i
deally..suited..for..the..pregnant..patient..who..may..experience..a..routine,..uncomplicated..course..of..
prenatal..care,..labor..and..delivery,..or..there..may..be..a..variation..in..costs..due..to..complications..th
at..require..treatment..and/or..result..in..a..C-
section..or..preterm..delivery..(or..both);..the..frequency..of..the..episodes..will..vary,..but..are..certainly.
.lower..than..for..a..chronically..ill..patient..with..frequent..exacerbations..and..episodes..that..include..
hospitalizations..throughout..the..year.
Also..supportive..of..the..OB..patient..is..that..in..this..model,..the..physician..has..the..flexibility..to
..order..services..without..the..restrictions..of..prior..authorization..that..other..models..may..require..(
Miller,..2009)...This..allows..the..physician..to..provide..time-
sensitive..care..and..services..when..they..are..needed..and..allows..the..provider..to..closely..monitor..t
he..pregnancy..and..proactively..treat..any..potential..complications..that..are..diagnosed..before..they
..result..in..a..negative..outcome.
C1:..Pro..Forma..Budget
3
