You Decide Project Paper

You Decide Project
Cooper-Pearson Sports Marketing

Keller Graduate School of Management

July 17, 2013

You Decide Project
My research paper will discuss HMO and PPO by contrasting and comparing, as well as indemnity insurance program. Also I will discuss which of these three managed care programs is the best service for Cooper-Pearson. And will answer the following questions; (1).Discuss the importance of managed-care physician credentialing, (2). Explain the benefits of a prescription drug program to the employer and the employee, and (3). Explain the importance of quality- management indicators in managed-care programs.

First of all, before we make the decision on which of these managed-care organizations is a better service for
Cooper-Pearson, we must know what they are and what service they provide. A HMO is a type of managed care organization that provides a form of healthcare coverage in the
United States that is fulfilled through hospitals, doctors, and other providers with which HMO has a contract.
A PPO (Preferred Provider Organization) is a managed care organization of medical doctors, hospitals, and other healthcare providers who have covenanted with a insurer or a third-party administrator to provide healthcare at reduced rates to insurer’s or administrator’s clients. And a indemnity insurance program is an insurance program that aims to protect business owners and employees when they are found to be at fault for s specific event such as misjudgment.
Here are the advantages and disadvantages of HMO and PPO:
The advantages of an HMO is that their health plans have lower health premiums for both the employer and the employee. Another advantage is that there is no deductible for the patient. The only thing that is required is the prescribed co-payment for services that may run between $15 and $20 a visit. In addition, the co-payment for outpatient and hospitals services is substantially reduced as well in comparison to a regular PPO health plan. The main disadvantage for HMO plans is the fact that you can only go to a prescribed list of doctors, if your physician is not listed on the plan, then you will have to obtain special permission to pay a higher proportion of
the cost of the office you visit or you will have to pay for the entire treatment of that physician.
Another disadvantage for HMO involves the use of specialists in the treatment of patients. The main advantage of PPO plan is that you can have a wider array of physicians to choose for your health needs. Also you do not have to report a primary care physician to the insurance company or call a primary care physician for referrals to specialists.

In conclusion, after reviewing the different managed care organization or insurance plans, I believe that Cooper-Pearson should choose a PPO health plan. The reason is that you can choose from a variety of healthcare professionals and you do not have to call a primary care physician for referrals. However, if the employees were given the option to have both plans, then make this will decrease the problems that in happening, as well as improve recruitment and retention.

Citations
"Health Maintenance Organization." Wikipedia, the Free Encyclopedia. Web. 17 July 2011. .
Preferred Provider Organization. Web. 15 July 2011. .
"Prescription Drug Benefits | The American Worker, Inc." The American Worker, Inc. | Limited Medical Plans | Mini Medical Plans | Limited Benefit Medical Plans. Web. 17 July 2011. .
"Pros and Cons of HMO and PPO Plans - Selecting HMO vs. PPO Plans - Epinions.com." Reviews from Epinions. 19 Oct. 2001. Web. 17 July 2011. .