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Instruc!ons Assignment #5 Overview: Assume you are a Maryland resident and Medicaid recipient looking to enroll in a managed care plan, review the Maryland Managed Care Website(s) at: h"ps:// h"ps:// Assess and evaluate HealthChoice, Maryland’s statewide mandatory managed care program based on the following evalua!on criteria. Please choose one (1) of the MCO's under HealthChoice to evaluate. Using the table format below, answer the ques!ons (using a narra!ve format) in each sec!on that appear in bold type. Please be sure to include a reference page. Student Name: Type your name here Assignment #5 Title HealthChoice/Maryland Managed Care Plan Benefits Offered and Services Covered You want a plan that offers a comprehensive benefits package including preven"ve care as well as treatment programs for chronic disease management. Also, you may need emergency care and/or care away from home. What ques!ons would you ask to determine the benefits and covered services offered? Evaluate the HealthChoice plan and summarize your findings. Page 2 of 4 Cost vs. Benefits Managed care plans vary widely in the cost of services offered. It may be temp"ng to base your selec"on primarily on the periodic, out-of-pocket costs to you. You can’t be sure that the least expensive plan will give you all the medical services you need. Review cost vs. benefits for the HealthChoice plan carefully and summarize your findings. Services of the Primary Care Physician Choosing your primary care physician (PCP) may be the most important decision you make when enrolling in a managed care plan. The following ques"ons are important when choosing your plan: Please answer each ques!on. Can you choose more than one PCP for your family? Is there a large choice of primary care doctors and specialists? How long is the average wait to get an appointment with the chosen PCP? Can you see the same doctor consistently? When and how can you change doctors if you are dissa!sfied How does HealthChoice measure up? Prescrip!on Drug Benefits When evalua"ng a health plan it is very important to know what kind of prescrip"on drug benefits the plan offers. Depending upon the plan, there are several systems that have been implemented in efforts to control costs. Some plans offer a “generic only” plan. What prescrip!on drug benefits does HealthChoice offer? Are they beneficial to your current drug regimen? Provider Network and Geographic Service Area Be sure you inquire from the Provider Membership Directory which providers are included in the network and where they are located in your community. If you live in one community and work in another; determine if rou!ne care can be received in either loca!on. Does HealthChoice have a strong network of Providers in a geographic area that is amenable to you? Must you go to different loca!ons for different services? If you have a child away at school, does the network extend to that area? Commitment to Quality of Care What measures of quality care and sa!sfac!on of service are available? It is worthwhile to find out if the plan has been accredited by the Na"onal Commi#ee for Quality Assurance (NCQA). NCQA is the most common Page 3 of 4 and Service accredi"ng body for network plans. Review and report on what measures of quality care and sa!sfac!on are available for HealthChoice. Customer Sa!sfac!on How do enrolled members feel about the plan? There are various objec"ve forms of measurement used to determine “quality services” given by managed care plans such as accredita"on, HMO report cards and/or publica"ons produced by the industry. You would be wise to look at any that measure customer sa"sfac"on. The Na"onal Commi#ee for Quality Assurance (NCQA) mission is to provide informa"on that enables purchasers and consumers of managed health care to compare plans based on quality. Their web site may be reached at h#p:// Limita!ons, Maximums, or Exclusions Life"me Cap refers to the maximum dollar amount of benefits available to a consumer in a managed care plan during his or her life"me. This amount becomes important when confronted with a life-threatening disease or accident that requires prolonged care involving expensive therapeu"c interven"on and support. Does HealthChoice outline limita!ons, maximums, or exclusions?

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