MHA628 Week 4 Discussion.
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School
University Of Arizona *
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Course
628
Subject
Health Science
Date
Nov 24, 2024
Type
docx
Pages
4
Uploaded by ArizonaAssignmentHelp
Managed Care Organizations [WLOs: 1, 2] [CLOs: 1, 4, 5]
Prior to beginning work on this discussion forum, review the following:
Chapter 6: Sales, Governance, and Administration
Quality Indicators Associated With the Level of NCQA Accreditation
Download Quality Indicators Associated With the Level of NCQA Accreditation
Health Insurance: Changing Healthcare With Aetna (CXOTalk #317)
Links to an external site.
Group Health Insurance Explained
Links to an external site.
Health Plan Accreditation
Links to an external site.
For this discussion forum, you are taking on the role of the human resources director in a large health system. Your CEO is unhappy with the current health insurance company due to their poor member services and claim processes. You are tasked to find another company that provides excellent member services and timely claim processes. Your benefits consultant, who represents several insurance companies, is on Family and Medical Leave (FMLA) for 2 months. You decide to search online and locate a top-rated health insurance company (e.g., UnitedHealth, Aetna, etc.). Using the health insurance company that you found, compile the critical information about what they offer to make an informed choice.
In your initial post,
Describe the member services of the health insurance company you found online (e.g., UnitedHealth or Aetna).
Discuss current or upcoming technology that benefits plan members.
Examine the member’s outreach program and incentives for wellness and prevention.
Identify its accreditation or certification, and its commitment to excellence and quality.
Generate at least one suggestion to improve the company’s member services or website.
Your initial post should be at least 500 words. Support your response with a minimum of two credible sources published in the last 5 years. Your sources must be formatted according to APA Style
Links to an external site.
as outlined in the Writing Center. The Scholarly, Peer-Reviewed, and Other Credible Sources
Links to an external site.
table offers additional guidance on appropriate source types. Guided Response: Due by Day 7.
Describe the member services of the health insurance company you found online (e.g., UnitedHealth or Aetna). In my role as the Human Resources Director, tasked to finding a new health insurance company for a large health system, I conducted thorough research and identified Blue Cross Blue Shield (BCBS) as a top-rated health insurance provider with excellent member services and timely claim processes (National Committee for Quality Assurance, 2018). BCBS offers a wide range of member services, including comprehensive health coverage, personalized health management tools, and access to a vast network of healthcare providers (Blue Cross Blue Shield, 2019). Members can benefit from services like online appointment scheduling, telehealth consultations, and prescription drug coverage, enhancing their overall healthcare experience. Discuss current or upcoming technology that benefits plan members.
BCBS is at the forefront of leveraging technology for the benefit of its plan members. They have recently introduced a user-friendly mobile app that allows members to access their health insurance information, find in-network providers, and even schedule appointments directly from their smartphones (Blue Cross Blue Shield, 2019). Additionally, BCBS is investing in upcoming telemedicine advancements, ensuring members have convenient access to virtual consultations, promoting timely and efficient healthcare services (Blue Cross
Blue Shield, 2019). Examine the member’s outreach program and incentives for wellness and prevention.
BCBS has implemented a proactive member outreach program, conducting regular health screenings, sending timely reminders for preventative care appointments, and organizing wellness workshops (Blue Cross Blue Shield, 2019). They offer incentives for members engaging in wellness and prevention activities, such as discounts on gym memberships, rewards for achieving fitness goals, and reduced premiums for maintaining a healthy lifestyle (Blue Cross Blue Shield, 2019). These incentives encourage members to actively participate in their health and well-being. Identify its accreditation or certification, and its commitment to excellence and quality.
BCBS holds accreditation from the National Committee for Quality Assurance (NCQA), a testament to their commitment to excellence and quality in healthcare services (National Committee for Quality Assurance, 2018). This certification signifies their conformity to demanding quality standards and best practices, ensuring members receive high-quality care and services. BCBS consistently focuses on improving patient outcomes and enhancing the overall quality of care provided to its members (Blue Cross Blue Shield, 2019). Generate at least one suggestion to improve the company’s membership services or website. While BCBS offers a strong set of member services, one area for improvement could be enhancing the user interface and navigation of their website. Simplifying the website layout and ensuring intuitive navigation can significantly improve the online experience for members (Wan et al., 2022). Implementing a more user-friendly interface would empower members to easily access information, find healthcare providers, and utilize more online tools, thereby enhancing overall member satisfaction.
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