M8 models/PPO Discussion - Assignment Example

Managed Care Advantages of Different Insurance Models The various dental care insurance models include preferred provider organization (PPOs), consumer directed health plans (CDHPs), health maintenance organizations (HMOs) and point-of-service (POS).Network HMOs provide provider groups with negotiated, capitated compensation rates. Providers are reimbursed based on the service provided although the number of services that they can deliver is limited by the amount subscribed by the subscribers (Edwards, Fox & Stonier, 2010).

Health care providers are reimbursed as a group and therefore do not have to follow insurers to be reimbursed. On the other hand, PPO enables members to select providers from a network of preferred providers and does not limit members to preferred providers. This organization enables individual or private dental care providers to benefit from the insurance as opposed to the HMOs where only the selected providers benefit from the model. Providers outside the group of preferred providers are able to receive higher reimbursement compared to the selected network of providers.

In addition, PPO pay a range of 70 to 80 percent of the expenses, with the rest subjected for payment by the patient (Kongstvedt, 2009). This strategy enables patients to seek specialized treatment thereby benefiting various specialists in dental care. POS is a hybrid between an HMO and PPO and also allows health plan members to use non-participating or non-network providers though at a reduced level of benefits. POS is characterized by higher co-payments, and higher deductibles which in turn benefit the providers.

Consumers have responded favorably to the flexibility of POS with the lower costs of HMOs thereby benefiting both the preferred providers and those outside the list of preferred dental providers (Edwards, Fox & Stonier, 2010). The pay for service delivered system applied in this model has enabled both public and private dental care providers to benefit from the increasing number of people seeking dental care services Evaluate PPOs as a Model of Managed Care PPO is a model of managed care that contracts with providers to deliver healthcare services at a negotiated discount off their standard fees or the usual and customary rate, which is the standard for services in a given geographical region.

PPO has been found to encourage plan members to select providers from a network of preferred dental care providers. This enables the organization to regulate the quality of services provided to their subscribers through vetting of providers and giving their clients a group of reliable dental care providers from a given region to choose from (Edwards, Fox & Stonier, 2010). However, PPO may allow selection of dental care providers outside the selected or preferred providers to give subscribers a wide scope of dental service providers to select from.

In addition, selection of network providers, enable subscribers to pay co-payments and deductibles than if they were to select a non-network providers. The coverage allows health plan members to use non-participating or non-network providers offering their services at reduced deductibles. The coverage covers about 80 percent of expenses incurred by a patient in accessing any type of dental care thereby significantly reducing the burden incurred by patients in receiving specialized care (Kongstvedt, 2009).

This coverage has particularly enhanced accessibility of specialized dental care services since patients are only required to pay a small percentage of all costs incurred in receiving such care. The model further benefits dental care providers through its efficient reimburse system accomplished through recognition of specific groups or networks of dental care providers.ReferencesEdwards, L., Fox, A & Stonier, P. (2010). Principles and practice of pharmaceutical medicine. Stamford, CT: John Wiley & Sons.

Kongstvedt, P. (2009). Managed care: What it is and how it works: What it is and how it works. New York, NY: Jones & Bartlett Learning.