Healthcare Policy: Ethical Factors for HMO

You are the HMO Vice President of Operations for NuCare HMO. The HMO President tells you that the board is considering discontinuing Medicare affiliation. The board wants to know how this will impact their membership in rural areas where there is no other HMO that is affiliated with Medicare.

The president directs you to create a five- to six-slide PowerPoint presentation to present to the Board of Directors.  The presentation should briefly outline what the likely outcome would be for rural membership if the HMO stops attending to Medicare patients. Include the following considerations in your presentation:

  • The difficulty members may face in finding new care options
  • The concerns that may need to be addressed for members seeking new care options
  • Whether members will be able to acquire Medicare gap insurance
  • Make a final recommendation as to whether NuCare should discontinue its Medicare affliation.

Use headings, bold, and bulleted lists in your presentation. Use the notes section in PowerPoint to clarify your responses or add additional detail where warranted.

The attached article discusses what happens to patients when their HMO decides to discontinue serving Medicare patients. The article contrasts the different experiences among people who live in areas where there is a choice of another Medicare HMO against the experiences among people who live in areas where there is not another HMO.

Source: Booske, B. C., Lynch, J., & Riley, G. (2002). Impact of Medicare managed care market withdrawal on beneficiaries. Health Care Financing Review, 24(1), 95-115.

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