Financial Status of Healthcare Organizations

Evaluate the financial condition of HC organizations.
Millions of consumers are enrolled in a managed care organization (MCO) model, and the numbers are expected to increase over the years. In order to control healthcare (HC) cost, employers have moved to managed care health plans as an alternative to fee-for-service plans. In the fee-for-service model, providers charge a fee for each service or procedure delivered to the patient. Managed care, however, provides a range of HC products and services to consumers in an effort to keep the lowest possible cost and to help patients avoid serious health problems.

You are the chief financial officer (CFO) of a nonprofit organization, Seamus Company, and have been asked to analyze the company’s health insurance plans for any cost-saving measures. You have also been thinking of innovative ways to help reduce cost, such as leveraging resources through HC partnerships. HC coverage is the sole principal employee-related expenditure for most employers (aside from salaries). Employers are shifting the HC cost to their employees by encouraging them to think more about health-related expenses and behavior. Employers increasingly offer incentives to remove spouses from employee plans. Employers may charge workers extra if a covered spouse has access to other insurance, or they may pay bonuses when spouses are not on the company policy.

A. Create a report that includes the following:
1. Propose three fiscally sustainable strategies for Seamus Company from the perspective of a CFO, moving away from a fee-for-service model to a MCO model. The word strategy is misleading. What you are asked to do is choose three MCO models (EPO, HMO, POS, PPO, HDHP, IPA) and describe the models (benefits and structure).
a. Recommend a plan to carry out each of the three sustainable strategies from part A1 by including the following: (SEE CHAPTER 3, Section 3.4 MCO). In this section you will describe each model by addressing the following:
• cost-saving measures
• tax deductible considerations
• other tax advantages
• fiscal management improvements
b. Discuss two financial management principles of Seamus Company that would support your recommended plan from part A1a. In this section you will choose one of your models and describe the effect two of the four Cs will have on Seamus company (Cost, Control, Cash, Capital)
c. Discuss how the strategies from part A1 align to Seamus Company’s goals of reducing the costs of the company’s health insurance plans.
2. Choose one of the models from part A1 to analyze the use of increased service benefits for Seamus Company by doing the following:
a. Discuss the HC utilization risk strategy that Seamus Company may face.
b. Describe three financial benefits to Seamus Company with the implementation of increased service benefits.
c. Describe three potential financial drawbacks to Seamus Company with the implementation of increased service benefits.
d. Explain how an employee’s increased usage of these service benefits can be beneficial to Seamus Company.
3. Analyze external HC partnerships and their financial benefits by doing the following: (wellness company, gym, pharmacy)
a. Discuss two financial benefits from external HC partnerships.
b. Discuss two financial drawbacks from external HC partnerships.
c. Determine whether an external HC partnership would be beneficial for Seamus Company.
d. Justify your determination of whether an external HC partnership would be beneficial for Seamus Company.
B. When you use sources, include all in-text citations and references in APA format.

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