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1* Managed care was created to help reduce the cost of health care. The three major managed care plans are HMO, PPO, and POS. Most Americans who have health insurance are under a managed care plan. HMO’s are responsible for providing or coordinating health care services to their covered members through affiliated providers who are reimbursed under various methods (Konstvedt, 2007). Managed care plans through HMO’s are less expensive with lots of restrictions. They have restrictions like limited visits, test, and treatment. The book states,”most PPO’s contract directly with hospital, physicians, and other diagnostic facilities” (Kongstvedt, 2007). If you are under a PPO you can seek health care outside of their network but at a higher cost. “They also feature a network of providers, but there are fewer restrictions on seeing non-network providers. In addition, your PPO insurance will pay if you see a non-network provider, although it may be at a lower rate” (Medical Mutual, 2015). POS plans allow you to go to outside the network at a higher deductible. You need to have a primary care physician to see a specialist and other services otherwise the service may not be covered.

 

2* Managed care was created to help reduce the cost of health care. The three major managed care plans are HMO, PPO, and POS. Most Americans who have health insurance are under a managed care plan. HMO’s are responsible for providing or coordinating health care services to their covered members through affiliated providers who are reimbursed under various methods (Konstvedt, 2007). Managed care plans through HMO’s are less expensive with lots of restrictions. They have restrictions like limited visits, test, and treatment. The book states,”most PPO’s contract directly with hospital, physicians, and other diagnostic facilities” (Kongstvedt, 2007). If you are under a PPO you can seek health care outside of their network but at a higher cost. “They also feature a network of providers, but there are fewer restrictions on seeing non-network providers. In addition, your PPO insurance will pay if you see a non-network provider, although it may be at a lower rate” (Medical Mutual, 2015). POS plans allow you to go to outside the network at a higher deductible. You need to have a primary care physician to see a specialist and other services otherwise the service may not be covered.

 

3* Health insurance providers have tried a number of strategies to enhance marketing appeal to customers in order to offer better and improved choices regarding health care plans. Companies have developed customer advisory groups, which consist of insurance brokers, patients besides physicians to enable companies to offer better services to customers. These stakeholders are well connected and meet adequately with administrators from insurance companies to discuss strategies that can be employed to improve clinical and marketing strategies. These groups are essential since they provide a forum, which builds trust with many customers since they feel represented (Sobo, Herlihy & Bicker, 2011). Companies have developed healthcare support tools, which assist customers to choose their preferred plan. These tools aid patients in selecting preferred health care providers, hospitals besides the most appropriate doctors. Customers are provided with report cards that show comparative information regarding health providers and plans as well as the background information about a physician. These cards offer tools regarding various treatment options and specific care. Insurance companies adapted information tools to enable patients' access significant material and understand key implications of choosing the insurance plan. A number of times patients require assistance when they need to change their physician and health plan. Through these tools, they have the necessary information on whom to consult for immediate actions (Lemanski & Villegas, 2015).

 

4* Health insurance companies must increase their consumer appeal to attract buyers to their company. Purchasers are selectively purchasing care in a competitive market (Lazerow, 2014), especially since the Affordable Care Act and the advent of health exchanges, which help to facilitate the purchasing of insurance. Health insurance companies must not only attract the business of employers but also individuals who are now purchasing for themselves and their families. One example, as detailed by a Blue Cross and Blue Shield Executive, is appealing to individual buyers by first determining who these individuals are. BC/BS uses external sources of data and data through Acxiom that can build profiles of communities so they know exactly who to target (Schultz, 2013). Using this data, they discovered there is a large Latino market and the target market is younger than their current demographic. Being that the target market is younger, they tend to be more text and mobile enabled as compared to the older PC-enabled age group. BC/BS developed campaigns that could be used through text. BC/BS are still using traditional media methods but are specifically advertising on Spanish language media more so than in the past and took up advertising on bus stops in parts of town that have a higher uninsured population. ealth insurers are also focusing on low-cost products. Health insurance companies are aware that consumers are highly price conscious and therefore seek lower priced products (November, Cohen, Ginsburg, Quinn, 2009). A key strategy is to expand high deductible health plans and limited-benefit products, both of which are different approaches to cost savings. High deductible plans usually lack first dollar coverage but provides protection against catastrophic medical events and limited benefit products offer first dollar coverage for some services but do not over major medical expenses. Offering limited benefit products is especially appealing to healthier individuals who do not foresee any major medical situations and who want to be able to use the “up-front” benefits. Some consumers view this type of insurance as an affordable alternative to a more comprehensive plan. Insurance companies have expanded on high deductible pans by offering preventive care benefits. With this as an option, insurers are hoping to attract the healthier population.

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