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You are the manager of a large orthopedic practice who participates in the BPCI program. Your practice does 400 total knee patients each year

Question 1: Request health plan information from the human resources department in your work setting. (If you do not have personal access to a human resources department, request information from a friend or family member’s workplace). Summarize the components of the health plan including benefits, coinsurance, copayments, and deductibles. Explain how this plan addresses each of the following:

·  Adverse selection

·  Moral hazard

·  Cost control

·  Cost sharing

·  Access to care

Your response should be 3–4 paragraphs in length.

RUBRIC BELOW:

0 Not Present

1 Needs Improvement

2 Meets Expectations

Module 1: Economics of Health Insurance

Summarize the components of the health insurance plan including benefits, coinsurance, copayments, and deductibles.

LO1.1: Summarize the components of a health insurance plan.

Response is not present.

Response is vague, inaccurate, and/or incomplete.

Response is clear, accurate, and complete.

Explain how the health insurance plan addresses adverse selection.

LO1.2: Explain how the health insurance plan addresses adverse selection.

Response is not present.

Response is vague, inaccurate, and/or incomplete.

Response is clear, accurate, and complete.

Explain how the health insurance plan addresses moral hazard.

LO1.3: Explain how the health insurance plan addresses moral hazard.

Response is not present.

Response is vague, inaccurate, and/or incomplete.

Response is clear, accurate, and complete.

Explain how the health insurance plan addresses cost control.

LO1.4: Explain how the health insurance plan addresses cost control.

Response is not present.

Response is vague, inaccurate, and/or incomplete.

Response is clear, accurate, and complete.

Explain how the health insurance plan addresses cost sharing.

LO1.5: Explain how the health insurance plan addresses cost sharing.

Response is not present.

Response is vague, inaccurate, and/or incomplete.

Response is clear, accurate, and complete.

Explain how the health insurance plan addresses access to care.

LO1.6: Explain how the health insurance plan addresses access to care.

Response is not present.

Response is vague, inaccurate, and/or incomplete.

Response is clear, accurate, and complete.

QUESTION 2: Scenario 2You are the manager of a large orthopedic practice who participates in the BPCI program. Your practice does 400 total knee patients each year. Medicare has set pricing for a total knee replacement patient at $28,415 per patient for a 90-day episode of care. Current practice is that all patients automatically go to an SNF for 20 days. Based on current research, the goal is for 60% of your patients to go home with home care and those going to an SNF to stay for 10 days so the BPCI program will be profitable. Consider measures you might recommend, e.g., consider length of stay, reducing readmissions, attracting new business, care redesign, patient satisfaction, and physician engagement

Provide a redesign strategy you might recommend for the scenario you chose. Some redesign strategies you might consider are included with each scenario, but you are not limited by them.

·  Justify why you selected the redesign strategy and how you would implement it.

o  Be specific and provide an example.

·  Locate a scholarly article to support the redesign strategy and give a brief summary of the outcomes or results of the implementation of the strategy.

o  Be sure to include the article’s title and author in APA format.

RUBRIC BELOW:

Not Present 1

Needs Improvement 2

Meets Expectations

Module 3: Quality, Health, and Reduced Spending using redesigned VBP program

Provide a redesign strategy you might recommend for the scenario you chose.

LO3.1: Recommend a redesign strategy for the chosen scenario.

Response is not present.

Response is vague, inaccurate, or incomplete.

Response is clear, accurate, and complete.

Justify why you selected the redesign strategy.

LO3.2: Justify the selection of a redesign strategy.

Response is not present.

Response is vague, inaccurate, or incomplete.

Response is clear, accurate, and complete.

Explain how you would implement the redesign strategy.

LO3.3: Explain the implementation of a redesign strategy.

Response is not present.

Response is vague, inaccurate, or incomplete.

Response is clear, accurate, and complete.

Summarize the outcomes or results of the implementation of the strategy discussed in the supporting scholarly article.

LO3.4: Describe the outcomes/results of the redesign strategy discussed in a scholarly article.

Response is not present.

Response is vague, inaccurate, or incomplete.

Response is clear, accurate, and complete.

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