Essay Available:
page:
3 pages/โ825 words
Sources:
2
Style:
APA
Subject:
Management
Type:
Essay
Language:
English (U.S.)
Document:
MS Word
Date:
Total cost:
$ 12.96
Topic:
The request for proposal (RFP) department in an MCO
Essay Instructions:
You are responsible for the request for proposal (RFP) department in an MCO. Several employers have come to you looking for health insurance benefit offerings to its employees. You are to provide a package of health care insurance benefit coverage recommendations based on the size of each company: small group, medium group, and large group.
For each company size, recommend the services you would offer that sized company. Include how those services would be organized. You may assume anything you want about the employer. Incorporate your assumptions into your paper.
Be sure to include such things as what payment systems would be implemented (fee-for-service? capitation? deduction? and so forth).
How would you incorporate inpatient and outpatient services? How would you handle behavioral health services?
For each company size, your paper should be about 2 to 4 pages in length. Double space and use 1 inch margins all around in 12 point Times New Roman font.
Use headers freely to help outline your various recommendations for structure and content
There is no one correct answer to this. Your task is to demonstrate through this assignment that you understand the structure, internal operations of MCOs and health care options as presented in the text.
When writing, consider these questions:
What might a small/medium/large group employer look like?
What sort of financial structure would you recommend?
What would be the physician relations and so forth?
Use the text as a guide as to other factors that should be included in your paper. Details are good here.
Consider the reader in how you structure each of your employer recommendations. Do not write paragraphs that are 50 lines long. Break up your content into paragraphs that reflect changes in topic or thought. As stated above, use headers freely. Proper grammar is important. Proof read your assignment for spelling and grammar before you submit it.
For information on APA formatting review this five minute tutorial. Review a sample paper.
Submit this assignment to the dropbox "Assignment 10: Employer RFP." This assignment is worth 200 points and will be graded according to the scoring guide below.
SCORING GUIDE (200 POINTS)
Rating Scale
20-19 Work meets or exceeds criterion at a high level of competence.
18-17 Work reflects an understanding of criterion with minor misunderstandings/misconceptions.
16-15 Criterion partially met, but one or more important concepts/skills are missing or flawed.
14-13 Work reflects an attempt to meet criterion, but significant misunderstandings/misconceptions are apparent.
12-0 Criterion not met or work is absent.
Criteria
1. Paper address each employer group: small, medium and large.
2. Paper addresses payment systems.
3. Paper addresses inpatient services.
4. Paper addresses outpatient services.
5. Paper addresses mental health services.
6. Paper considers financial structure.
7. Paper cites references if/when appropriate.
8. Paper includes 2 to 4 pages per plan for each employer group size.
9. Paper exhibits correct and appropriate grammar, punctuation, spelling, syntax, and word usage.
10. Paper is on time.
Essay Sample Content Preview:
The Request for Proposal (RFP) Department in an MCO
Studentโs Name
Institutional Affiliation
The Request for Proposal (RFP) Department in an MCO
The size of the workforce remains a vital consideration when tailoring health insurance benefits for various organizational workforces. To a request for a proposal department (RFP) in a managed care organization (MCO), the services, structure, and financial models may differ. In this analysis, emphasis is put on exploring tailored health insurance benefit packages for three organizational categories: small group (1-50 employees), medium group (51-250 employees), and large group (251+ employees) organizations. The recommendations for insurance packages must be unique for individual organizations and consider the number of employees while outlining the inpatient and outpatient packages as well as defining the payment systems and the assigned behavioral health services.
Small Group Employer
In a small group employer, there are assumptions to explore before settling on the appropriate packages. Firstly, it is assumed that such an organization has 50 or fewer employees. Also, most of the employees are full-time and are tied to cost-effective packages considering budget limitations for such organizations. Such an organization should also have younger workers and families (Glassman, 2017). For such an entity, the recommended services should include core health benefits with basic inpatient and outpatient services. The cover should also constitute preventive care like check-ups and vaccinations. Secondly, the cover should accommodate behavioral health services that include access to a limited network of counselors and therapists. The service should also beat a short-term assistance program for limited mental health support (Cleverley, 2021). The recommended package should also have pharmacy benefits with coverage for generic medications accommodated.
The other key considerations for a small organization should be the organization of services and payment systems. For service organizations, the stakeholders can focus on either a narrow network or the coordination care option. The narrow network option implies a partnership with local healthcare facilities to create networks with an emphasis on limited costs. For coordination of care, the services can be subcontracted to a primary care provider (PCP) and an introduction of wellness programs accommodated. The financial model for such a company should be a fee-for-service (FFS) model that emphasizes preventive care options. Additionally, there can be a consideration for health savings accounts (HSAs) to ease the management of out-of-pocket costs.
Medium Group Employer
A medium-group employer should have be...
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