Lake Sumter State College Health Care Policy Discussion Responses

Hello, Thank you for your help.POST # 1A-J:  What was important about the growth of managed care in the late 1980s? How has it evolved in today’s market (e.g., PPOs, POS plans). Describe other plans that have been developed to replace or supplement the managed care insurance model (e.g., Catastrophic insurance, CDHPs, Health Savings Accounts, and Flexible Spending Accounts). In your opinion, does this increase in consumer choice of health insurance options result in greater access to insurance/healthcare or the quality of care provided?Sara GonzalezHi everyone!What is essential about the growth of managed care in the late 1980s is that it was a progressive strategy to provide access, a business strategy to control costs, a government strategy to control costs and achieve access, and a political strategy to avoid National Health insurance (Hahn, 2020). Today, over 150 million Americans can rely on employers in the marketplace for insurance. With these private insurance plans, variety is allowed. It offers traditional indemnity insurance or a combination of models that fall under managed care plans such as health maintenance organizations, preferred provider organizations, or point of service plans (Hahn, 2020) PPO allows for individuals’ benefits of indemnity and managed care. If within the network, the cost is heavily discounted, and if out of network, a portion is still covered. POS is another hybrid insurance policy that loosens the gatekeeping restrictions imposed by HMOs. Point of service allows enrollees to decide which provider they see without receiving prior authorization from a PCP (Hahn, 2020). Another plan developed is the Healthy Savings Accounts, this allows individuals covered by high deductible health plans to receive tax advantages for money saved to cover personal medical expenses. Funds within an HSA are not subject to federal or payroll tax; it is an account holders individual account and can be used to pay for qualifying medical and pharmacy expenses (Hahn, 2020). The employer or employee can put in funds, and all deposits to an HSA become the policyholder’s property, regardless of the source and the deposit. HSA allows enrollees to use the money to pay for the out-of-pocket expenses before they meet the deductible. Funds deposited roll over into the following year; if the policyholder ends their insurance coverage, they lose eligibility to deposit their funds, but funds remain available (Hahn, 2020).In my opinion, the increase in consumer choice of health insurance results in excellent access to healthcare and quality of care provided. For instance, if you are not satisfied with the insurance coverage provided by your employer, you can research potential better benefits through other policies. With the variety of insurance options, you can choose what suits your life; additionally, if the provider you prefer is out of network, the opportunity to still see them is available even though it covers a fraction of the cost or results in a fee. Hahn, J. (2020). Private health insurance market. In D.M. Nickitas, D.J. Middaugh, &  V.D. Feed (Ed.), Policy and politics for nurses and other health professionals: Advocacy in action (3rd ed., pp. 207-224). Jones & Barlett Learning.Post # 2K-P:  As a result of the passage of the Affordable Care Act, private insurers have responded by becoming proactive and adjusting their business model making patient satisfaction their ultimate goal. What are some of the actions private insurers have taken to adjust to the Affordable Care Act requirements?Dana PetersonPrivate health insurance companies have changed since the Affordable Care Act was passed. Because of financial reasons, many have withdrawn themselves from state health insurance marketplace exchanges. The business models of private insurance have also changed since the Affordable Care Act was passed. Private insurances have shifted more towards being proactive and putting a heavy focus on patient satisfaction. According to Hahn, J., private insurances have changed from insurance carriers to consumer health solutions companies (2020). Insurance websites have also received a facelift citing things like their goals of improving access to high-quality cost-friendly care and offering best practices. Technological advances are also being made, evidenced by new online and mobile device applications to assist consumers with gaining access to vast provider networks. Reimbursement is offered on wellness and prevention programs. Said programs include stress-reduction programs, cholesterol screening, smoking cessation programs, and education and monitoring for common conditions like hypertension. The new benefit designs have many perks, including controlling overall costs, encouraging healthy lifestyles, and offering financial incentives (Hahn, 2020). ACOs, or accountable care organizations, are also being promoted on private insurance websites as a means to provide more personalized care through coordination. The new care models that were previously mentioned will affect policy change and could even accelerate it by working to break down barriers and provide access to care for the populations most needing it (Hahn, 2020). Many opportunities exist for nurses to advocate in ways that can affect healthcare policies because of their unique position. Nurses can establish links between quality patient outcomes and care coordination strategies. Hahn, J also mentioned how nursing case managers have opportunities to assist families through the continuum of care while working as nurse coordinators and navigators and transition to care coaches (2020). Even higher up, nurse executives have the opportunity to make their organizations accountable care organizations. It is clear that private insurers have done a lot to respond and adapt to the passage of the Affordable Care Act. Many of the things the private insurers have changed creates new opportunities for nurses to play a pivotal role in policy change, research, and advocacy. ReferencesHahn, J. (2020). Private health insurance market. In D. Nickitas, D. Middaugh, & V. Feeg (Eds.), Policy and politics for nurses and other health professionals advocacy and action (3rd ed., pp. 207-229). Jones & Bartlett Learning.