Case Study:
The employees who work in Atlanta, Georgia drive in from 14 counties. It is made up of various types and sizes of companies, employing all ages and ethnic groups.
The ABC Insurance Company was very aggressive and quite successful in recruiting companies, organizations, and individuals to join its Managed Care Plans. They spread out among the 14 counties on a very aggressive sale campaign selling a very good managed care package to employers and organizations. Their success was part of their problem.
Some employers and employees of the contacting companies wanted to include the XYZ Hospital because of its excellent reputation in quality maternity care and cardiac rehabilitation.
When the ABC insurance company approached The XYZ Hospital to recruit them for participation as a provider of their Managed Care Plan, the XYZ Hospital became very demanding.
The XYZ Hospital demanded that in order for them to sign on as healthcare provider, all maternity care and cardiac patients in the plan must be seen at the XYZ facility or it would not sign the contract.
Many employers pressured the ABC Insurance Company so they agreed to XYZ Hospital stipulations and enrolled the XYZ Hospital in the plan. This was a legal binding contract for both parties.
This created several problems.
- This would mean that a patient might need to drive 50 miles and pass 4 or 5 good hospitals in the plan in order to get the care they needed.
- The patient's attending OB physician(s) or Cardiac physician(s) did not have privileges at the XYZ Hospital. These physicians threatened to dis-enroll from the plan.
- To give them privileges would mean more staff meetings and Emergency Room duty at a far away hospital. These physicians threatened to dis-enroll from the plan.
- The existing staff physicians at the XYZ Hospital objected to the loss of available hospital space and time, as well as, the possibility of the loss of existing patients to the new physicians. These physicians threatened to dis-enroll from the plan.
- The other hospitals in the managed care plan objected to the loss of patients and threatened to dis-enroll from the plan, and to sue for restraint of trade.
QUESTIONS:
Q1. What should the ABC Insurance Company do? Why? How?
Q2. What should XZY Hospital do? Why?
Q3. What should the employers do? Why? How?
Q4. What should the patients do? Why? How?
Your answer must be typed, double-spaced, Times New Roman font (size 12), one-inch margins on all sides, APA format.