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Healthcare Economics

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<p align=”center” style=”margin-bottom:0in;margin-bottom:.0001pt; text-align:center”><b>Agency</b></p>
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<p align=”center” style=”margin-bottom:0in;margin-bottom:.0001pt; text-align:center”><b>Type of Healthcare Organization impacted</b></p>
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<p align=”center” style=”margin-bottom:0in;margin-bottom:.0001pt; text-align:center”><b>Aspects of Governance</b></p>
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<p style=”margin-bottom:0in;margin-bottom:.0001pt; text-indent:-.25in”>1.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; National Association of Insurance Commissioners (NAIC)</p>
<p style=”margin-bottom:0in;margin-bottom:.0001pt”>The NAIC is an organization that offers support services when it comes to setting standards and regulations. Chief insurance regulators from all states and territories of the United States including the District of Columbia created the organization.</p>
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<p style=”margin-bottom:0in;margin-bottom:.0001pt”>Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Point of Service (POS) plans.</p>
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<p style=”margin-bottom:0in;margin-bottom:.0001pt”>The Health Insurance and Managed Care (B) Committee is responsible for all matters pertaining managed care. Regarding financial regulation, the committee analyzes factors that lead to rising costs of health care and premiums. Also, it reviews initiatives being taken to deal with cost drivers.</p>
<p style=”margin-bottom:0in;margin-bottom:.0001pt”>The NAIC also deals with solvency issues through the CO- OP Solvency and Receivership (B) Subgroup (National Association of Insurance Commissioners, n.d.).&nbsp;</p>
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<p style=”margin-bottom:0in;margin-bottom:.0001pt; text-indent:-.25in”>2.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Centers for Medicare and Medicaid Services</p>
<p style=”margin-bottom:0in;margin-bottom:.0001pt”>CMS is a federal government agency that aims to increase health insurance coverage while striving towards high quality and cost- effective healthcare. It covers 100 million people (CMS, n.d.).</p>
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<p style=”margin-bottom:0in;margin-bottom:.0001pt”>Medicaid Managed Care</p>
<p style=”margin-bottom:0in;margin-bottom:.0001pt”>Medicare managed care</p>
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<p style=”margin-bottom:0in;margin-bottom:.0001pt”>In the CMS, the Division of Managed Care Plans (DMCP) is responsible for all technical issues regarding managed care.</p>
<p style=”margin-bottom:0in;margin-bottom:.0001pt”>The division regulates financial aspects of managed care such as capitation rates, projected benefit costs, pass- through payments, risk mitigation, and contractual provisions (Iglehart, 2011).&nbsp;</p>
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<p style=”margin-bottom:0in;margin-bottom:.0001pt; text-indent:-.25in”>3.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; State Machinery</p>
<p style=”margin-bottom:0in;margin-bottom:.0001pt”>State governments are responsible for the bulk of regulation in the case of managed care organizations.</p>
<p style=”margin-bottom:0in;margin-bottom:.0001pt”>In most states, multiple departments/ agencies regulate health care plans. Some states even differentiate between Preferred Provider Organizations (PPO) and Health Maintenance Organizations (HMO). States exemplified in this case are California and Iowa.</p>
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<p style=”margin-bottom:0in;margin-bottom:.0001pt”>California</p>
<p style=”margin-bottom:0in;margin-bottom:.0001pt”>HMOs</p>
<p style=”margin-bottom:0in;margin-bottom:.0001pt”>California Department of Managed Health Care.</p>
<p style=”margin-bottom:0in;margin-bottom:.0001pt”>PPOs</p>
<p style=”margin-bottom:0in;margin-bottom:.0001pt”>California Department of Insurance</p>
<p style=”margin-bottom:0in;margin-bottom:.0001pt”>California Department of Managed Health Care.</p>
<p style=”margin-bottom:0in;margin-bottom:.0001pt”>Iowa</p>
<p style=”margin-bottom:0in;margin-bottom:.0001pt”>Both HMOs and PPOs</p>
<p style=”margin-bottom:0in;margin-bottom:.0001pt”>Iowa Insurance Division</p>
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<p style=”margin-bottom:0in;margin-bottom:.0001pt”>The Department of Managed Health Care (DMHC) defends consumer rights in addition to acting as a regulator in the state. There are a couple of offices under the Department: &ldquo; Office of the Director, Help Center, Office of Enforcement, Office of Legal Services, Office of Administrative Services, Office of Technology and Innovation, Office of Financial Review, Office of Plan Licensing, and Office of Plan Monitoring&rdquo; (DMHC, n.d.). As a financial regulator, the agency is responsible for monitoring health care costs and monitoring the financial solvency of the system.&nbsp;</p>
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<p align=”center” style=”text-align:center”>&nbsp;</p>

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