Case Study: Should Medicaid And Hmos Join Forces?

Should Medicaid and HMOs join forces?
In order to market the HMO’s product, the representative has indicated that if Medicaid patients are enrolled in their program, there will be cost efficiency and improvement in quality of care. According to Medicaid.gov, a 2014 CMS Actuarial Report indicated 72.5 million people enrolled in the Medicaid program. Medicaid is a program to provide health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Each state funds its Medicaid program in combination with the federal government. An HMO is defined by HealthCare.Gov as “A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO”. There are various types of HMO models that are available, depending upon the desired need.
M. Duggan notes, “Managed care could lower spending without sacrificing quality”. As an example, Duggan illustrates that paying providers a flat fee per patient may discourage them from providing services of minimal value and encourage more preventative care. Duggan also states, …show more content…
Santa indicates as part of an NCQA rankings of the states based on 2010 performance data, some Medicaid HMOs are outperforming others. Enrollees are satisfied with some and struggling with others. Medicaid plans are sold by health insurance companies as well as community plans. The difference between a community plan and health insurance companies is with a community plan it is usually a non-profit. Health insurance companies can be either for profit or non-profit. Community plans belong to one of two national associations that stress that their Medicaid HMO members are focused on quality improvement and innovation. Based on the performance data, the association claims appear to be correct. The larger health insurance companies, such as Amerigroup, Blue Cross/Blue Shield, Molina, and United Health did not rank in the top

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Case Study: Should Medicaid And Hmos Join Forces?

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