Hcs 235 Week 3 Assignment Part

HEALTH INSURANCE MATRIX1Health Insurance MatrixModelDescribe the modelHow is the care paid or financed when this model is used?What is the structure behind this model? Is it a gatekeeper, open-access, or combination of both?What are the benefits for providers in using this model?What are the challenges for providers in using this model?Health MaintenanceOrganization (HMO)HMO is a managed care insurance plans that offer provisions of health care services on the capitated or prepaid basis to its members for a fixed amount of fees (Clack, Renfroe, and Rimmer, 2015). There are several models for HMOs. First is staff model HMO includes salaried employees e.g. physicians and others thatprovide care to only HMO-enrolled members. The second is group HMO model involves a large number of doctors that are under contract to provide care to its The members of the HMO pay a fixed monthly fee to receive health care. Further, they also pay a small co-payment for each time they visit a doctor. Further, different reimbursement plan exists in the differentorganizational structure. For example in staff, HMO model physicians are usually salaried and receive incentive or bonuses related to planning The HMOs can employ open-endedor close-ended or the combination of both. The open-ended form is opento private physicians who form a contract with the HMOs for providing care to its members. Therefore, they rely on the private physicians in providing care. In contrast close-ended structure employs a doctor or single medical group to provide Following are the benefits for providers including receiving salaries in an advance for care those required by HMO enrollees. The HMO model fosters preventive measures meaning that if the medical expense is less then higher will be the provider income. Further, the PCPs can build a long-term relationship with their patients. Moreover, if the HMO provider offers care to fewer The challenges associated with this model include sharing of the financial risks with some physicians or the entire network of doctors. Further, especially in a closed-ended HMO plan, the physicians have more restriction with whom they can work on an exclusive basis forservices and are not allowed to see those patients that belong to another

2Health Care Providers and ProductsThe health care system is complicated. There are many health care providers and servicesout there. Some of them are preventative care or public health; ambulatory or primary care; subacute or long-term care; acute care; auxiliary services; rehabilitative services; end-of-life care; mental health services; emergency management or disaster preparedness; dental services; military and veteran services; and Indian health services. Each of these providers offers its individual service or product, but in the long run, they all benefit each other to help the patient that needs it. The two that are going to be discussed are rehabilitative services and mental health services. I will give a basic description of the provider or service and the products that go along with it.Rehabilitative servicesRehabilitative services are a series of treatments designed to expedite the process of recovery from different injuries such traumatic brain injuries, illness such as strokes, or from a disease. Rehabilitative services help people come back to as normal a condition as possible.There are many types of rehabilitative services. These include physical therapy, occupational therapy, speech therapy, inhalation therapists, audiologists, and registered dietitians.There are many more types, but these are the most well-known. These services are done in a lot of settings such as the clinic and office practices, in the hospital itself, nursing homes, and in sports medicine. There are even some rehabilitative services that are done through home visits. Ifa person needs help to find the right type of therapy for them they should talk to their doctor.

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