Assess and evaluate HealthChoice, MD’s statewide mandatory managed care program

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Overview: Assume you are a Maryland resident and Medicaid recipient
looking to enroll in a managed care plan, review the Maryland Managed
Care Website(s) at: https://mmcp.health.maryland.gov/healthchoice/Pages/HealthChoice-Enrollment.aspxhttps://mmcp.health.maryland.gov/healthchoice/pages/home.aspxAssess and evaluate HealthChoice, Maryland’s statewide
mandatory managed care program based on the following evaluation
criteria. Please choose one (1) of the MCO’s under HealthChoice to evaluate. Using the table format below,
answer the questions (using a narrative format) in each section that
appear in bold type. Please be sure to include a reference page. APA
format required.
HGMT 420 Assignment #5
Student Name:
Type your name here
Assignment #5 Title
HealthChoice/Maryland Managed Care Plan
Benefits Offered and Services Covered
You want a plan that offers a
comprehensive benefits package including preventive care as well as
treatment programs for chronic disease management. Also, you may need
emergency care and/or care away from home. What questions would
you ask to determine the benefits and covered services offered? Evaluate
the HealthChoice plan and summarize your findings.
Cost vs. Benefits
Managed care plans vary widely in
the cost of services offered. It may be tempting to base your selection
primarily on the periodic, out-of-pocket costs to you. You can’t be sure
that the least expensive plan will give you all the medical services
you need. Review cost vs. benefits for the HealthChoice plan carefully and summarize your findings.
Services of the Primary Care Physician
Choosing your primary care
physician (PCP) may be the most important decision you make when
enrolling in a managed care plan. The following questions are important
when choosing your plan: Please answer each question.
Can you choose more than one PCP for your family? Is there a large choice of primary care doctors and specialists? How long is the average wait to get an appointment with the chosen PCP? Can you see the same doctor consistently? When and how can you change doctors if you are dissatisfied
How does HealthChoice measure up?
Prescription Drug Benefits
When evaluating a health plan it
is very important to know what kind of prescription drug benefits the
plan offers. Depending upon the plan, there are several systems that
have been implemented in efforts to control costs. Some plans offer a
“generic only” plan. What prescription drug benefits does HealthChoice offer? Are they beneficial to your current drug regimen?
Provider Network and Geographic Service Area
Be sure you inquire from the
Provider Membership Directory which providers are included in the
network and where they are located in your community. If you
live in one community and work in another; determine if routine care can
be received in either location. Does HealthChoice have a strong network
of Providers in a geographic area that is amenable to you? Must you go
to different locations for different services? If you have a child away
at school, does the network extend to that area?
Commitment to Quality of Care and Service
What measures of quality care and satisfaction of service are available? It
is worthwhile to find out if the plan has been accredited by the
National Committee for Quality Assurance (NCQA). NCQA is the most common
accrediting body for network plans. Review and report on what measures of quality care and satisfaction are available for HealthChoice.
Customer Satisfaction
How do enrolled members feel about the plan? There
are various objective forms of measurement used to determine “quality
services” given by managed care plans such as accreditation, HMO report
cards and/or publications produced by the industry. You would be wise to
look at any that measure customer satisfaction. The National Committee
for Quality Assurance (NCQA) mission is to provide information that
enables purchasers and consumers of managed health care to compare plans
based on quality. Their web site may be reached at http://www.ncqa.org/
Limitations, Maximums, or Exclusions
Lifetime Cap refers to the maximum
dollar amount of benefits available to a consumer in a managed care
plan during his or her lifetime. This amount becomes important when
confronted with a life-threatening disease or accident that requires
prolonged care involving expensive therapeutic intervention and support.
Does HealthChoice outline limitations, maximums, or exclusions?

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