Medical

Practice

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ROSALIND FRANKLIN UNIVERSITY OF MEDICINE AND SCIENCE

Medical Practice Strategies:  Systems Based Practice - Business Laws Ethics

Janet Lerman, J.D.

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PERSPECTIVES - Class 1  

Framework for Analysis

A method to help analyze the evolving healthcare delivery system:

bullet Employer Groups 
bullet HMO/PPO/MCO/Insurer 
bullet Providers
bulletPatient 
bullet Laws and Public Policy

In summary, a framework for analysis of managed care analyzes the evolving health care delivery system from each of the following perspectives:

(1)     Employer Groups which are the companies/businesses that pay for the health care benefits. For purposes of this analysis, federal sponsored health care programs such as Medicare and Medicaid, are to be considered part of this group.

(2)     HMO/PPO/MCO/Insurer which are the companies offering the healthcare insurance type of coverage products, such as Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), other Managed Care Organizations ("MCO’s") and insurance companies.  

(3)     Providers which are all of the different types of health care providers rendering medical care to the patients, including physicians, hospitals, pharmacies, etc., encompassing the entire continuum of care to patients. 

(4)     Patient who is subject to the medical care rendered by the providers and the terms for health care coverage available under the health care insurance policy.

(5)     Laws and Public Policy which refers to laws or public policies currently enacted or pending or that do not currently exist but should be considered that affects any of the above four categories.

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