MMHA6400 All Weeks Discussions Latest 2020 JUNE

MMHA6400 Healthcare Financial Management and Economics

Week 1 Discussion

Shifting From Volume to Value

A key reform goal of the 2010 Affordable Care Act was to create a healthcare system that rewards providers for achieving optimal care outcomes at a sustainable cost. As part of the law, the federal government has tested and implemented several new payment models designed to achieve this goal for the Medicare program; Such payments are presented to a great extent in the Medicare Cost Report (MCR). For this week, your assignment is to explore the role the MCR plays in a value – based health care system.  Specifically, address issues included in the report like facility characteristics, utilization data, cost and charges by cost center.  Furthermore, choose a couple of utilization metrics (data) and address how it is computed. Please assume a hospital setting.

To prepare for this Discussion:

Review the following website for more help in starting your paper: https://www.cms.gov/Medicare/Medicare

Analyze the current economic shift from volume-based health care to value-based health care. What economic principles (macro and micro) are driving this shift? What role does the Medicare Cost Report play in this shift?

Evaluate implications of this volume to value shift. How has this shift affected how you work or how you or a family member has been treated for a medical condition?

By Day 3

Post a cohesive response to the following:

Analyze economic principles that are driving the shift from volume-based health care to value-based health care. Then, evaluate implications of this volume to value shift. Provide an example of how this shift has affected how you work or how you or a family member has been treated for a medical condition.

Support your response by identifying and explaining key points and/or examples presented in the Learning Resources.

Read a selection of your colleagues’ postings. Consider how your colleagues’ postings relate to the information presented in the Learning Resources and to your own posting.

By Day 5

Respond to at least two of your colleagues’ postings and continue the Discussion through Day 7. Expand on this Discussion by describing challenges associated with the shift from volume-based to value-based health care. Include how you might approach this challenge in a health care organization.

 

 

 

 

 

MMHA6400 Healthcare Financial Management and Economics

Week 3 Discussion

Design of Health Insurance Policies

Health insurance is designed to protect patients from the risk of expensive medical services. The cost of insurance, however, is steadily rising. When costs are too high, healthier individuals tend to not purchase insurance coverage, resulting in a lower percentage of healthy individuals to pool with those who have health issues. This poses a challenge for employers and the government, as they are tasked with designing viable policies that balance cost and generosity of benefits. For this Discussion, examine the following scenario and consider the type of insurance policy the employer should design and provide for employees.

Scenario:

You are the employee benefits manager for a mid-sized construction company with 50 employees. You are responsible for working with insurance companies to design a health insurance policy to meet your company’s needs. An analysis of the health risks of your company’s employees indicated that there are two populations of typical individuals: 20­- to 30-year-old workers with no known health issues and 40- to 50-year-old workers with chronic diabetes. Assume that 40% of the employees fall into the second category of workers with chronic diabetes.

To prepare for this Discussion:

Analyze the provided scenario. What is the obligation of the employer and the government in insuring these two populations of individuals? How do moral hazard and adverse selection impact these insurance provisions?

Consider the type of insurance policy the employer should design and provide for its employees. Be sure to consider type and generosity of coverage, premiums, deductibles, and cost-sharing.

By Day 3

Post a cohesive response to the following:

Analyze obligations of the employer and the government in insuring the two populations of individuals described in the scenario. Evaluate the impact of moral hazard and adverse selection on these insurance provisions. Then, recommend the type of health insurance policy the employer should design and provide for its employees. Defend your recommendations.

Support your response by identifying and explaining key points and/or examples presented in the Learning Resources.

Read a selection of your colleagues’ postings. Consider how your colleagues’ postings relate to the information presented in the Learning Resources and to your own posting.

By Day 5

Respond to at least two of your colleagues’ postings and continue the Discussion through Day 7. Expand on this Discussion by highlighting differences between your own posting and your colleagues’ postings. Provide additional insights or alternative perspectives.

 

 

MMHA6400 Healthcare Financial Management and Economics

Week 4 Discussion

Health Care Reimbursement and Utilization Management

Accountable care organizations (ACOs) are designed to promote value and quality in health care. They use new payment and delivery models that include incentives to improve care coordination and utilization management. With these models, ACOs contract with private insurers and/or Medicare to receive reimbursement, and then the ACO determines how to contract with physicians and other medical providers to provide health care services to patients. Since not all providers are direct employees of ACOs, there are potential challenges with reimbursing the affiliated providers in a way to maximize efficiency, increase quality, and lower utilization. For this Discussion, examine the following scenario and recommend strategies for reimbursement and utilization management.

Scenario:

Medicare and private payers have expanded reimbursement under Accountable care organizations (ACO). You are the chief financial officer (CFO) of a hospital system that is forming an ACO to participate in these payment models. The ACO seeks to improve care coordination for its patients with chronic conditions. To provide better care management, the ACO is interested in investing in primary care physicians and physician’s assistants to provide more intensive care management services. After formation, the ACO will enter contracts with Medicare and private insurers under alternative payment models, including shared savings, bundled payments, and global capitation. The ACO will need to determine how to set up reimbursement payments to ACO providers and consider whether financial incentives are required to ensure ACO providers deliver efficient care.

To prepare for this Discussion:

Read the provided scenario.

Consider strategies for reimbursement and utilization management, including financial incentives.

How might you set up the reimbursement payments to ACO providers, considering the alternative payment models (i.e., fee for service, shared savings, bundled payments, or global capitations)?

What utilization management controls might you add to align the interests of ACO providers?

By Day 3

Post a cohesive response to the following:

As the CFO of the ACO in the provided scenario, recommend strategies for reimbursement and utilization management. Defend your recommendations.

Support your response by identifying and explaining key points and/or examples presented in the Learning Resources.

Read a selection of your colleagues’ postings. Consider how your colleagues’ postings relate to the information presented in the Learning Resources and to your own posting.

By Day 5

Respond to at least two of your colleagues’ postings and continue the Discussion through Day 7. Expand on this Discussion by contrasting your colleagues’ recommendations with your own. Provide alternative perspectives.

MMHA6400 Healthcare Financial Management and Economics

Week 5 Discussion

Health Care Organizational and Market Structures

In an industry as complex as health care, organizational and market structures must be carefully considered. To participate in accountable care organizations (ACOs) and other value-based care initiatives, for example, hospitals need to have a coordinated care organization model across ambulatory care, acute care, and other settings. Developing these coordinated relationships may require vertical integration to ensure efficient utilization. Although there are many advantages to this integration of organizational and market structures, there are some disadvantages for both the hospital and the providers. For this Discussion, examine the following scenario and recommend strategies for the organizational integration of the hospital and practice.

Scanario:

You are the chief financial officer (CFO) of a hospital located in a highly competitive, urban market split with two competing hospitals. The hospital is considering purchasing or affiliating with a large physicians’ practice. Your hospital has 30% market share, but does not currently have any owned/employed physicians. Private insurers and Medicare are aggressively pushing value-based reimbursement under ACO contracts, and the one competing hospital has already acquired a large physicians’ practice.

To prepare for this Discussion:

Analyze the provided scenario. What are the advantages and disadvantages of the vertical integration of the hospital and physicians’ practice? What economic factors should be considered?

Consider strategies for the organizational integration of the hospital and physicians’ practice. Be sure to address the economic factors you identified.

By Day 3

Post a cohesive response to the following:

Compare advantages and disadvantages of the vertical integration of the hospital and physicians’ practice, including economic factors that should be considered. Then, recommend strategies for the organizational integration of the hospital and practice. Defend or argue your recommendations using economic principles.

Support your response by identifying and explaining key points and/or examples presented in the Learning Resources.

Read a selection of your colleagues’ postings. Consider how your colleagues’ postings relate to the information presented in the Learning Resources and to your own posting.

By Day 5

Respond to at least two of your colleagues’ postings and continue the Discussion through Day 7. Expand on this Discussion by providing additional insights or alternative perspectives.

 

 

MMHA6400 Healthcare Financial Management and Economics

Week 6 Discussion

Regulation, Policy, and Economic Efficiency

One of the assumptions of value-based care is that if consumers are aware of price, then they can make better decisions about the health care services they receive. In an effort to encourage this efficiency in health care, government regulation and policy has been designed to promote transparency of quality and cost information. For this Discussion, examine the following scenario and consider how regulation and policy on hospital cost transparency might improve economic efficiency.

Scenario:

On behalf of consumers, employers and local purchasers in your market are committed to slowing health care costs by improving visibility on hospital prices. A recent media story revealed that prices in your local market were the highest in the state. You are a member of a private sector consulting service that has been hired to help a hospital address transparency issues. The hospital would like to be more transparent in their cost and fee relationships with providers.

To prepare for this Discussion:

Review the provided scenario. What are the advantages of transparency for both the hospital and the consumer? How might hospital cost transparency improve economic efficiency?

Consider current (last 5 years) regulation and policy to compare hospitals based on their costs. Locate and review literature to support your recommendations.

By Day 3

Post a cohesive response to the following:

Analyze advantages of transparency for both the hospital and the consumer. Include how hospital cost transparency might improve economic efficiency. Then, recommend regulation and policy to compare hospitals based on their costs. Defend your recommendations.

Support your response by identifying and explaining key points and/or examples presented in the Learning Resources.

Read a selection of your colleagues’ postings. Consider how your colleagues’ postings relate to the information presented in the Learning Resources and to your own posting.

By Day 5

Respond to at least two of your colleagues’ postings and continue the Discussion through Day 7. Expand on this Discussion by provided additional insights or alternative perspectives.

 

 

 

 

MMHA6400 Healthcare Financial Management and Economics

Week 9 Discussion

Working Capital

Working capital, or actual cash available for spending, is the key to a successful organization. In a health care organization, it is important to determine how much cash is available to run the day-to-day operations. For this Discussion, you analyze the working capital of a health care organization of your choice.

To prepare for this Discussion:

Locate and select financial statements for a particular health care organization. Analyze the working capital of the organization.

Consider the impact of regulations, business plans, and economic dynamics on the working capital requirements of the business. Is there sufficient working capital for business operations of the organization you selected?

By Day 3

Post a cohesive response to the following:

Analyze the working capital of the health care organization you selected. Evaluate the impact of regulations, business plans, and economic dynamics on the working capital requirements of the business. Include whether or not there is sufficient working capital for business operations and explain why.

Support your response by identifying and explaining key points and/or examples presented in the Learning Resources.

Read a selection of your colleagues’ postings. Consider how your colleagues’ postings relate to the information presented in the Learning Resources and to your own posting.

By Day 5

Respondto at least two of your colleagues’ postings and continue the Discussion through Day 7. Expand on this Discussion by providing additional insights or alternative perspectives to your colleagues’ postings.

 

MMHA6400 Healthcare Financial Management and Economics

Week 11 Discussion

Ethics in Health Care Finance

As a health care administrator, you will undoubtedly be faced with the responsibility of making decisions that may be impacted by ethics. Sometimes, the best approach to a given situation is clear, whereas others require you to carefully consider laws, regulations, and the impact of potential outcomes. How do you ensure you will make the best decision for your health care organization? For this Discussion, you examine the following scenario and consider whether there is a breach of ethics.

Scenario:An organization is developing a business plan. The intent of the organization is to provide a service for a community in need, but it appears they might have trouble obtaining financing. The board is trying to decide whether to be transparent in their financials or over-predict so they can properly finance their venture.

To prepare for this Discussion:

Read the provided scenario.

Given the mission of the organization in the scenario, consider whether over-predicting financials would be a breach of ethics.

By Day 3

Post a cohesive response to the following:

Evaluate whether overstating financials would be a breach of ethics for the organization in the scenario. Why or why not?

Support your response by identifying and explaining key points and/or examples presented in the Learning Resources.

Read a selection of your colleagues’ postings. Consider how your colleagues’ postings relate to the information presented in the Learning Resources and to your own posting.

By Day 5

Respond to at least two of your colleagues’ postings and continue the Discussion through Day 7. Expand on this Discussion by providing additional insights or alternative perspectives.