Healthcare Barriers & Solutions: Cedars-Sinai & Cigna's HMOs Case Study, Exams of Nursing

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CLC- Health

CareBarrier

Solution

Presentation

By Romarie Garlitos,

Justin Whitehouse,

Your text here 1

Miranda Gomez,Cielo

Woggn, Trinity Provchy,

Julieta Montejano, &

Jasmine Bonilla

Solutions to health care barriers

➔ (^) Health care barriers ◆ (^) “Barriers may exist if individuals are underinsured and cannot afford the cost sharing required by their health insurance policy…” (Wilensky, Teitelbaum, 2020, Page 75) ➔ (^) Solutions ◆ (^) Language Barriers- Different tools like Google Translate or Interpreters ◆ (^) Transportation Healthcare Access Barriers- Partnerships or programs in the community ◆ (^) Lack of Communication- “parrot back” ◆ (^) Medical Bills- Telehealth is cost-effective ◆ (^) Insurance-Understanding Health Service Access

Cielo

Identify a health care barrier related to

access, cost, or a quality of care issue, at a

large hospital of 150 or more beds. ➔ (^) Hospital- Cedars-Sinai Medical Center ◆ (^) Barrier- Insurance coverage

➔ Solution they came up with: ◆ (^) Health Maintenance Organizations (HMO) ◆ (^) Preferred Provider Organizations (PPO) ◆ (^) Point of Service Plans (POS) ◆ (^) Exclusive Provider Organizations (EPO) ◆ (^) Medicare ◆ (^) Medi-Cal and Medicare and Medi-Cal (dual eligible)

Cielo

Suggest a vendor or program available

that could be implemented in this hospital.

➔ (^) Health Maintenance Organizations (HMO): ◆ (^) Emergency care ◆ (^) Out-of-area urgent care ◆ (^) Out-of-area dialysis (Centers of Medicare and Medicaid, 2020) ➔ (^) Possible Vendors: ◆ (^) Cigna ◆ (^) Centers Of Medicare and Medicaid

Trinity

Explain how the program is organized

(government, free market, sole

provider/monopoly). With Cigna

Government : Cigna offers Medicare and Medicaid

products and health, life and accident insurance

coverages primarily to individuals in the U.S. and

selected international markets

Sole Provider : Cigna plan is an independent

contractors solely responsible for the treatment

provided to their patient

Free Market: Access to a customer loyalty program

in most markets that rewards healthy lifestyle

activities that are included too. Cigna's 2021 plans

Julieta

Describe the differences that would exist

based on the program in a monopolistic,

oligopolistic, or free-market competition in

health care. ➔ (^) Monopoly ◆ (^) “... a single seller controlling the market” (Wilensky, Teitelbaum, 2020, Page 182) ➔ (^) Cigna

● (^) Price floor and ceiling ◆ (^) Only one product/ service ◆ (^) No other vendors ◆ (^) No entry into market

◆ (^) Control prices

Miran

da

Monopoli

stic

182)

Describe the differences that would exist

based on the program in a monopolistic,

oligopolistic, or free-market competition in

health care. ➔ (^) Oligopolistic ◆ (^) “... which have a few dominant firms and substantial but not complete barriers to entry”(Wilensky, Teitelbaum, 2020, Page

➔ (^) Cigna/ Anthem/ Humana ◆ (^) Control prices ● (^) Price floor/ ceiling ◆ (^) Low possibility of entry into market ◆ (^) Multiple products/ services

Miran

da

Oligopoli

stic

Describe the differences that would exist

based on the program in a monopolistic,

oligopolistic, or free-market competition in

health care. ➔ (^) Deregulated environment ◆ (^) Commercial Competition ◆ (^) Consumer Empowerment ➔ (^) Sets production/price of resource ➔ (^) "My vision is of a healthier America, an America healthier than it's ever been, thanks to a health care system that is quality- focused and consumer-centered, integrated and linked by information technology. If fully realized, the next few years could well become a breakthrough era in health care” (Hanway, 1998). ➔ (^) Cigna-Insurance Coverage ◆ (^) Consumer decision of best insurance programs ◆ (^) Competition between Cigna and other insurance companies ● (^) Compete for lowest prices ● (^) Decreased policies/regulations ◆ (^) Affordability for insured consumers ◆ (^) Program initiatives for uninsured

Justin

Free-

market

Competiti

on

y

Free-Market

Free-market health care allows consumers the freedom to choose insurance companies, insurance programs, and the options of care necessary to fit their needs. Giving this ability to the commonwealth of the population and limiting the government involvement forces large corporations and organizations to compete for the lowest prices available. It may be unclear at times that these associations, whether government or private, only function with consumer involvement. If one health insurance company is providing programs, care, and benefits at an extremel lower cost than other organizations, the public will select the cheaper coverage over the more expensive. By this, organizations have no choice but to lower the prices.

Justi

n

What is the average cost per patient

treated?

Between the barriers and what each patient gets treated for and how long their stay may be in certain areas is when the money will come into play. Then the patients insurances will come next and they will cover as much as they can and will set out payment plans if needed after the new balance is due and the patients cannot pay that forward. “Patients were asked about monetary expenditures on drugs, laboratory tests, and other investigations, consultations with private practitioners, and transport, and also about the time taken to access services” (Floyod, pg. 440, 2006). All different medications and all the different types of medications cost certain amounts and certain blood test or x-rays will be pricey as well. The patient just need to do what is best for the health no matter how expensive it can be.

Jasmin

e

Each Patient Treated

Julieta

What is the documented or advertised

results of the program?

➔ (^) “To compare health care utilization in people with systemic lupus erythematosus (SLE) in health maintenance organizations (HMOs) and fee-for-service (FFS)” (Yelin, Trupin, Katz, Criswell, Yazdany, Gillis, & Panopalis, 2007). ◆ (^) Created a survey for those who had SLE to answer the following areas: ● (^) general health status and social functioning ● (^) demographics and socioeconomic status, ● (^) psychological and cognitive status ● (^) health insurance coverage ● (^) health care utilization ● (^) employment status ● (^) medications ● (^) SLE status ● (^) disability

Trinity

Romar

ie DESCRIBE THE DIFFERENCES IN

SUPPLY CURVE HEALTH CARE

● (^) Cost and benefit ● (^) Cost minimization ● (^) Cost of illness ● (^) Healthcare services are also based on external and internal factors ● (^) Supply in healthcare is inelastic

ECONOMI CS ● (^) “The relationship between the price of a good and the quantity supplied” (Mankiw, 2018, p.72) ● (^) Sellers offer a sale of certain prices in a designated extend of time ● (^) A drop in price could lead to a fall in quantity supplied ● (^) An increase in price could lead the quantity supplied to rise ● (^) Usually the sellers supply more when prices increases

Romar

ie (^) DESCRIBE THE DIFFERENCES IN

HEALTHCA RE

● (^) Derived Demand ● (^) Consumers can attain a bigger stock of “Health Capital” ● (^) It affects the changes in prices of healthcare

DEMAND CURVE ECONOMI CS

● (^) “Demand curve represents the relationship between price and quantity demanded” (Mankiw, 2018, p.39) including other products as well ● (^) Individuals can distribute resources to consume and produce health ● (^) Increase productivity (lessen sick leave and higher wages) ● (^) Demand in healthcare is inelastic

● (^) Ability and willingness to purchase products or services ● (^) A drop in price could cause a growth in demand ● (^) An increase in price could cause a decrease in demand

Jasmin Pictures

e

Pictures

Jasmin

e

Pictures

Jasmin

e

References

50 Largest Hospitals in America: Lists 50 of the largest hospitals in the United States of American,

determined by number of beds. Becker's Hospital Review.

https://www.beckershospitalreview.com/lists/50-largest-hospitals-in-america.html

California Health Care Almanac. California Health Care Foundation. (2016, September).

https://www.chcf.org/wp-content/uploads/2017/12/PDF-AlmanacRegMktBriefLosAngeles2016.pdf

Centers of Medicare and Medicaid. (2020). Health Maintenance Organization (HMO). Retrieved October

17, 2020, from

https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-advantage

-plans/health-maintenance-organization-hmo

References

Cigna. (2020). Cigna Health Maintenance Organization (HMO). Retrieved October 17, 2020, from

https://www.cigna.com/individuals-families/plans-services/plans-through-employer/hmo

Cigna Executive Supports Fundamental Health Care Reform; Favors “Jackson Hole” Model. (1993). PR

Newswire.

Economics Help. (2020). Derived Demand. Retrieved from

https://www.economicshelp.org/blog/glossary/derived-demand/

Fitzpatrick, A. L., Powe, N. R., Cooper, L. S., Ives, D. G., & Robbins, J. A. (2004, October). Barriers to

health care access among the elderly and who perceives them.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448535/.

References

Floyd K, Arora VK, Murthy KJR, Lonnroth K, Singla N, Akbar Y, Zignol M, & Uplekar M. (2006). Cost and

cost-effectiveness of PPM-DOTS for tuberculosis control: Evidence from India. Bulletin of the World

Health Organization, 84 (6), 437-445. Retrieved from

https://eds-b-ebscohost-com.lopes.idm.oclc.org/eds/pdfviewer/pdfviewer?vid=3&sid=12573320-50

8b-4b63-bef5-bb775a371ac6%40pdc-v-sessmgr03

Free market produces better health care, official says. (1998). Westchester County Business Journal ,

37 (18),16.

Mankiw, G. (2018). Essentials of economics (8th ed.). Boston, MA: Cengage. ISBN-13: 9781337091992.

Moore, M. A. (2010). Review of The politics of media policy. Mass Communication & Society , 13 (2), 218–

220. https://doi-org.lopes.idm.oclc.org/10.1080/15205430903277937

References

Shri Guru Ram Institute Of Technology and Science. (2020). Retrieved from

http://webcache.googleusercontent.com/search?q=cache%3AhdD165p1h9gJ%3Awww.sgrrits.

org%2Fpdf%2Fe-content%2Fmanagement%2FDEMAND-AND-SUPPLY-IN-HEALTH-CARE.pdf

Wilensky, S. E., & Tietelbaum, J. B., (2020). Essentials of health policy and law (4th ed.). Burlington, MA:

Jones & Bartlett Learning. URL:

https://www.gcumedia.com/digital-resources/jones-and-bartlett/2019/essentials-of-health-policy-and-

law_4e.php

Yelin, E., Trupin, L., Katz, P., Criswell, L. A., Yazdany, J., Gillis, J., & Panopalis, P. (2007). Impact of health

maintenance organizations and fee-for-service on health care utilization among people with systemic

lupus erythematosus. Arthritis and rheumatism, 57(3), 508–515. https://doi.org/10.1002/art.22625