Hca-dq7-reply

Please reply to
William Polanco- Rowland–
Please note minimum of 200 words. Please cite one scholarly source. In-text citation should be included.

 The cost of healthcare and the associated dollar signs connected to it has kept a certain number of patients away from seeing a doctor when needed. The creation of Managed Care Organizations exists to deal with the exorbitant prices associated with seeing a healthcare provider and actually decreasing costs while increasing the level of care (Nikitas et al, 2020). The common thread is the network of providers that exists within each network that agrees to provide care for the policy holders for an agreed price. Among the Managed Care Organizations are three plans known as Health Maintenance Organization (HMO’s), Preferred Provider Organization(PPO’s), and Point-Of-Service Plan (POS). The structure of HMO’s exists as a network of hospitals, doctors and providers that usually only pay for care in the network visits. These have lower premiums the insured must use a provider within the network that is their Primary Care Physician (PCP). In addition, referrals must be obtained from the PCPs  for visits to specialists within the network (healthy.kaiserpermanente.org, 2022) Membership is generally required in the form of employment or one who  lives in the area of coverage. With an associated higher cost is the PPO’s. T​​hey will allow for visits to in or out of network providers as well as cost of fee coverage for visiting those out of network providers, generally covered by the increased monthly premiums and out of pocket costs (healthy.kaiserpermanente.org, 2022). The third plan being mentioned here is the Point-Of-Service Plan (POS). This is considered a hybrid of plans which allows for the insured to make decisions to see who they want as a provider without first obtaining prior approval. With regard to a plan that works best for the consumer, the HMO plan is one where the nurse within the system is most connected to the providers and the case files allowing for a seamless connection with provider to facility. The other two plans have steps between each provider and information can be lost in the shuffle. The position of nurses working within the healthcare system allows them an opportunity to help keep health costs down via means of self auditing, review of case files and review of the facilities that they are employed at. A nurse can self audit and review the cases they are in charge of and ones they are assigned for audit.  They can view the necessity of tests and the frequency of them, sounding the alarm on unneeded exams. They can use their knowledge of  billing to review charts to discover errors that might result in costly mistakes to patients and/ or facilities. Lastly, patients can take lessons for nurses in the form of education to learn about proper diet and eating habits, ways to manage lifestyle changes and