Also read: Billing Financial Management
Module 3 – Healthcare Models Primary Care
H320/HSA3170 SECTION 02 FINANCIAL MANAGEMENT OF HEALTHCARE ORGANIZATIONS
Primary care services are the foremost care services in a health care setting. The services provided in primary care include broad practice, public pharmacy, dental care, and optometry services. Primary health care is the first step in managing the provision of health care. The primary care doctor is the doctor that individuals visit for most medical needs, including wellness visits and routine screening and non-emergency illnesses such as sore throats (Loewenson, & Simpson, 2017). Patient-primary health care relationships can span for decades. However, they can also be short-lived as an individual can decide to change the insurance or move.
How the primary care model operates
Primary care is the first level of care that a patient receives, and the care is focused on the patient’s wellness and preventing the severity of the health conditions. The primary care provides the first point of connection that the patients have when they have medical concerns, and they have medical needs or concerns. The patient and the care provider’s primary care affiliation is also much of a long time when addressing their medical needs. The care providers follow a patient’s development and medical history for several years when providing them with the needed care. It is also provided in an outpatient setting where a low level of care is provided to the patient. Most of the patients in primary care make consultations, and they do not require hospitalization.
Primary care purposes to improve the patients experience while it also helps the patient to manage the expenditures. It helps the patient receive unconventional primary care services, and it has features that are explicitly designed to sustain practices caring for patients with chronic illnesses (Aalto et al., 2018).
Insurance in Primary care
In insurance, acceptability is one of the many things that need to be considered in healthcare. Efficiency, optimality, legitimacy, and equity are other factors that a client considers before taking an insurance cover. The insurance needs to conform to the client’s wishes, desires, and expectations as it may also be responsible for the client’s family members. The accepted insurance also depends on the client’s state (Rhodes et al. 2017). The accepted insurances include Tricare, United healthcare, IPN, Aetna, and Altius, among others. However, the patients need to confirm with the providers to ensure that they provide the primary care cover.
Services provided in primary care
There are different types of services provided in primary care. Some of the services include prevention, diagnosis, treatment, rehabilitation, monitoring the pregnancy course, and reducing the risk factors of illnesses. The care is provided through primary care physicians. Other physicians have different specialties and non-physician providers. The care is executed and generally achieved by personal physicians that frequently collaborate with other health professionals, and they also utilize consultations or referrals when appropriate.
Generation of revenues
Primary care physicians generate revenues through patient referrals, hospital admissions, tests, and inpatient treatments. The behavioral health specialists also generate revenues for the institutions through the services provided. The patients are charged for all the services that they are given under primary care. Some can pay for the services directly while the insurance companies cover others.
Primary care is delivered by the physician trained to work in specific fields. Some of the practices that they engage in are disease prevention, health maintenance, diagnosis, and treatment. The care is covered by different insurance companies based on the client’s preference. The care stimulates active communication with the patient heartening the patient role or partners in healthcare.
Aalto, A. M., Elovainio, M., Tynkkynen, L. K., Reissell, E., Vehko, T., Chydenius, M., & Sinervo, T. (2018). What patients think about choice in healthcare? A study on primary care services in Finland. Scandinavian Journal of Public Health, 46(4), 463-470. https://journals.sagepub.com/doi/abs/10.1177/1403494817731488
Loewenson, R., & Simpson, S. (2017). Strengthening integrated care through population-focused primary care services: international experiences outside the United States. Annual review of public health, 38, 413-429. https://www.annualreviews.org/doi/abs/10.1146/annurev-publhealth-031816-044518
Rhodes, K. V., Basseyn, S., Friedman, A. B., Kenney, G. M., Wissoker, D., & Polsky, D. (2017). Access to primary care appointments following 2014 insurance expansions. The Annals of Family Medicine, 15(2), 107-112. https://www.annfammed.org/content/15/2/107.short