Lecture 2 Flashcards
what should be considered when picking an insurance plan (1)
current health status of you and your family
your healthcare providers and what insurances they participate in
financial situation
what should be considered when picking an insurance plan (2)
whether you prefer paying more up front via premiums
do you want the flexibility and not want to have to ask for referral prior to seeing a specialist
types of insurances plans
preferred provider network
health maintenance organization
high deductible health plan
point of service plan
exclusive provider organization plan
what is the most common employer based health plan
preferred provider organization (PPO)
which plan has higher premiums and deductibles
much higher for PPO as compared to HMO
flexibility –> PPO
greater flexibility exists
no referrals
PCP –> PPO
do not need to choose or identify a primary care provider (PCP)
what does a PPO allow
in network and out of network care
out of network care will be more expensive
what still may be required –> PPO
authorizations for expensive services
what do PPOs typically have
higher deductible before the health plan pays for care
what exists with a PPO
an out of pocket maximum
one reached –> all costs are covered by your insurer
when will a PPO be right
when you want flexibility
willing to pay higher premiums
when you want flexibility –> PPO
to go out of network for coverage
do not want to obtain a referral from PCP first
willing to pay higher premiums –> PPO
but likely will pay less for health care services
what plan is 20% of all health plans
health maintenance organization (HMO)
what are HMOs characterized as
lower premiums
restricted network of doctors and hospitals
less flexibility
compared to PPO plans…HMO
pay less in premiums
what do HMOs require
identification of a PCP
PCP “coordinates” all care –> must see him/her for referral prior to seeking other services
what dont HMOs usually have
usually do not have deductibles
instead requires copays for office visits. test and prescriptions
what dont HMOs usually allow for
out of network care
going out of network requires you to pay on your own
what is the exception for going out of network –> HMO
emergency care
facility must bill in network but provider could still bill out of network
do all providers accept HMO plans?
no
when an HMO may be the right plan (1)
PCP and other providers are in the HMO network
do not have a need to see a specialist regularly so will not need a referral often
when an HMO may be the right plan (2)
limitation of only seeking care from in network providers is ok with you
cost is more important than flexibility
medicare
federal health insurance plan
for people 65 and older regardless of income, medical history or health status
parts of medicare
part A-D
medicare part A
covers inpatient hospital, SNF, home health visits and hospice
subject to deductible
medicare part B
covers physician visits, OP services, preventive services, and some home health visits
what doesnt medicare part B have
no co-insurance or deductible charged for annual wellness visit or preventative services
medicare part C
medicare advantage program
beneficiaries can enroll in a private health plan (HMO or PPO style plan)
what does medicare part C receive
all medicare covered part A and B services
often recieve part D benefits too
medicare part D
covers OP prescription drugs
SWOT analysis
enables organizations to identify internal and external influences
what does the SWOT analysis allow
for business to understand positive and negative factors that have an effect on strategic planning and decision making
parts of SWOT analysis
strengths
weaknesses
opportunity
threats
strengths –> SWOT
internal
positive attributes within your control
weaknesses –> SWOT
negative factors needed to improve on
opportunities –> SWOT
external factors that are likely to contribute to your success
threats –> SWOT
external factors you have no control over
VIRO framework
tool to evaluate a company strengths and weaknesses
how is the VIRO structured
in a series of four questions to be asked about the business activities of a firm
parts of the VIRO
value
rarity
imitability
organization
value –> VIRO
does your product/service provide value to the customer
rarity –> VIRO
are you the sole or one of the few providers with that capability?
imitability –> VIRO
are there notable barriers to copying your offering?
organization –> VIRO
is the business organized and ready to capture value?
what is organization about
the factors that are hard to emulate
factors that are hard to emulate –> organization –> VIRO
operational efficiencies
corporate culture
ability to innovate
develop plans that foster innovation
customer focused service
