Read the discussion and make one reply to the discussion. The reply do not need to be formal – but professional in nature. Include citations and 2 references. Ask 1 questions at the end of the reply. Discussion 1
Fee-for-service is a type of payment whereby healthcare providers are paid based on individual services that they render. An example of a service under this payment model could be a test or even an office visit (“Fee for Service, n.d.). Of note, this discussion is coming at a great time for me. In my new role at work, I will be learning and monitoring some of our value-based contracts. I honestly had no idea what value-based contracts, or models, were until last week. In my reading this week, the fee-for-service model seems to be quite the opposite of a value-based model. A couple of advantages for the fee-for-service model is that it can provide greater flexibility when choosing various treatment options and it is also a very transparent payment structure (Rajaee, 2023). Some disadvantages, however, can include the provider’s focus being more on quantity (seeing more patients and providing more services) rather than quality care. Moreover, costs are usually higher for the patient in the end with the fee-for-service structure (Rajaee, 2023).
When deciding on which two managed care plans I wished to compare and contrast, I wanted to aim for two of which I knew very little. Although I realize that HMO’s (Health Maintenance Organizations) have been around for some time and are generally a popular choice, I have never had an HMO until this year (when insurance prices skyrocketed)! This will be my first time with an HMO which was considerably cheaper than my employer’s other options. The other managed care plan that caught my eye was Point-of-Service (POS) plan, due to it being branded as the “fastest growing plan” (Harrington, 2021). The POS plan is similar to the HMO plan in that with both plans, the patient selects a Primary Care Physician (PCP). Also, with both plans, the PCP for a patient is a type of “gatekeeper” who assists managing and controlling costs and access for the patient as well as providing care coordination (i.e referrals to specialists) (Harrington, 2021). With an HMO plan, patients will usually pay 100% if they choose a provider out of the network. It’s a little more flexible with a POS plan in that patients may choose to go out of network and insurance will still pay. However, the payment made by insurance will be less than if the provider had been in network (Janzer, n.d.). The POS plan could be thought of as being somewhere in the middle of an HMO and a PPO (Preferred Provider Organization) whereby the PPO will also pay for an out-of-network provider, but does not require a PCP (Janzer, n.d.).
References
Harrington, M.K. (2021). Health Care Finance (2nd ed.). Jones & Bartlett Learning.
Healthcare.gov. (n.d.) Fee for service. Department of Health & Human Services. https://www.healthcare.gov/glossary/fee-for-service/Links to an external site.
Janzer, C. (n.d.) What’s the difference between an hmo, ppo, and pos? Trinet Zenefits. https://www.zenefits.com/workest/difference-hmo-ppo-pos/Links to an external site.
Rajaee, L. (2023, June 7). Fee for service vs value-based care: the differences, explained. Elation. https://www.elationhealth.com/resources/blogs/fee-for-service-vs-value-based-care-the-differences-explainedLinks to an external site.