design two incentive plans that will motivate the physicians and direct them to meet your organization’s goals.
A Plague Upon Us
You are an epidemiologist with the Department of Health and Human Services in Washington, D.C. You met this morning with the department director. She is concerned about the return of certain diseases, long considered conquered, such as the bubonic plague and polio, as these diseases have re-emerged in Africa and India in the past decade. The director is confident that the public health standards in the U.S. would not make the emergence or reemergence of those diseases on U.S. soil likely. However, since the risk of harm is so great if the diseases did emerge or re-emerge, she feels it is important to conduct a study/investigation of this matter. In addition, there is also a concern about bioterrorism in the U.S. in which terrorists could introduce “plague diseases,” such as small pox into the U.S. deliberately, and thus a study/investigation into the matter is doubly relevant.
Your orientation into this investigation is from the standpoint of a managerial epidemiologist, meaning that you are attempting to develop a strategic plan to prevent and control these potentially large-scale diseases. You are to draw up a preliminary memo that discusses five (5) primary objectives of managerial epidemiology and methodology to find the root cause of the reemergence in these third-world nations and five (5) possible techniques you could use to conduct this study. In your memo, be sure to be as specific as possible as to how you might address a catastrophic emergence of one or both of these diseases.
You may wish to refer to the MH601 Graduate Student Learning Guide, Lecture and Research Update, Assignment #3, pp. 3-4.
You are the administrator at Vision Health Care, Inc., a managed care organization. You are particularly pleased to have recruited three new physicians groups in the last two weeks. One of these groups of contracted physicians, Radiology Center of California, is located in Rosedale, California. The Center has never been a part of a managed care plan before. In fact, whenever they had been approached in the past, they had been highly resistant to the idea of managed care. The physicians at the Center are “old school,” all of them beginning their careers in the middle 1980s when Fee-For-Service was the primary mode of reimbursement.
In the last few years, however, they have suffered declining revenues as they have lost patients and failed to attract new ones because of the employer-sponsored managed care programs that now cover many patients. These patients desire the simplicity of handing the plastic membership card to the receptionist, who passes it off to someone else in the office, who then takes care of all of the billing aspects of the patients’ visits. The physicians in the Center have begun to recognize the need to contract with health plans.
Reviewing their file, you are especially impressed with the physicians group at the Radiology Center of California. Their skills and the level of their technology are exceptional. You know that this account will be an asset to your company, and you are determined to make the transition as smooth as possible for the physicians at the Center. You decide to meet with them as soon as possible to acquaint them with the incentives that are provided to physicians who contract with the plan.
You now must design two incentive plans that will motivate the physicians and direct them to meet your organization’s goals of quality, access, and low cost for plan members. One of the plans should be a capitation-fixed plan and the other should be a performance-based plan.