$3050\mathrm{.}1\mathrm{.}4$ : Financial Status of Healthcare Organizations

Evaluate the financial condition of healthcare organizations.

Introduction

Millions of consumers are enrolled in a managed care organization $($MCO$)$ model, and the numbers are expected to increase over the years. In order to control healthcare cost, employers have moved to managed care health plans as an alternative to fee$-$for$-$service plans. In the fee$-$for$-$service model, providers charge a fee for each service or procedure delivered to the patient. Managed care, however, provides a range of healthcare products and services to consumers in an effort to keep the lowest possible cost and to help patients avoid serious health problems.

Scenario

You are the chief financial officer $($CFO$)$ of a nonprofit organization, Seamus Company, and have been asked to analyze the company$$s health insurance plans for any cost$-$saving measures. You have also been thinking of innovative ways to help reduce cost, such as leveraging resources through healthcare partnerships. Healthcare coverage is the sole principal employee$-$related expenditure for most employers $($aside from salaries$).$ Employers are shifting the healthcare cost to their employees by encouraging them to think more about health$-$related expenses and behavior. Employers increasingly offer incentives to remove spouses from employee plans. Employers may charge workers extra if a covered spouse has access to other insurance, or they may pay bonuses when spouses are not on the company policy.

Requirements

Your submission must be your original work. No more than a combined total of $30\%$ of the submission and no more than a $10\%$ match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. An originality report is provided when you submit your task that can be used as a guide.

You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.

A$.$ Create a report $($suggested length $58$ pages$)$ that includes the following:

$1.$ Propose three fiscally sustainable strategies for Seamus Company from the perspective of a CFO, moving away from a fee$-$for$-$service model to a MCO model.

a$.$ Recommend a plan to carry out each of the three sustainable strategies from part A$1$ by including the following:

$$ cost$-$saving measures

$$ tax deductible considerations

$$ other tax advantages

$$ fiscal management improvements

b$.$ Discuss two financial management principles of Seamus Company that would support your recommended plan from part A$1$a$.$

c$.$ Discuss how the strategies from part A$1$ align to Seamus Company$$s goals of reducing the costs of the company$$s health insurance plans.

$2.$ Choose one of the strategies from part A$1$ to analyze the use of increased service benefits for Seamus Company by doing the following:

a$.$ Discuss the healthcare utilization risk strategy that Seamus Company may face.

b$.$ Describe three financial benefits to Seamus Company with the implementation of increased service benefits.

c$.$ Describe three potential financial drawbacks to Seamus Company with the implementation of increased service benefits.

d$.$ Explain how an employee$$s increased usage of these service benefits can be beneficial to Seamus Company.

$3.$ Analyze external healthcare partnerships and their financial benefits by doing the following:

a$.$ Discuss two financial benefits from external healthcare partnerships.

b$.$ Discuss two financial drawbacks from external healthcare partnerships.

c$.$ Determine whether an external healthcare partnership would be beneficial for Seamus Company.

i$.$ Justify your determination of whether an external healthcare partnership would be beneficial for Seamus Company.

B$.$ When you use sources, include all in$-$text citations and references in APA format.