Reference no: EM132821462

Dr. George Goodman operates a small direct primary care office out of Corona, Queens. His office staff consists of 4 individuals who handle all the administrative functions in the office such as checking in and out patients, insurance and billing, etc. In direct primary care, providers are paid cash by patients for their services and do not contract with third-party payers for reimbursement. Dr. Goodman is now considering contracting with a managed care organization (MCO) Metroplus, in order to participate in their Medicaid Managed Care Plan. He believes that contracting with the managed care organization (MCO) will result in an influx of patients and thus, more revenues.

• The Medicaid Managed Care plan under Metroplus, is a health maintenance organization (HMO) plan which follows the capitation model. Under capitation, Dr. Goodman will receive a per-member per month payment for each of his patients that is enrolled in Medicaid Managed care. Moreover, an influx of patients may potentially result in the need for more administrative support and an increase in supplies costs at the office.

Problem 1: Given what we know about the primary care practice, we can assume that the form of business operated by Dr. Goodman is a ______________.

Problem 2: Given the risks and incentives associated with different payment models, what considerations should Dr. Goodman take into account when adopting the capitation model of reimbursement?

Problem 3: Should Dr. Goodman contract with the MCO - Metroplus? Why or why not?

Problem 4: Because the Medicaid Managed Care Plan is an HMO, what should Dr. Goodman be aware of?

Problem 5: What do you believe are the benefits of not contracting with the MCO and remaining in a "cash only" or direct primary care model?