Maryland physicians care

Benefits offered and services provided

According to the Maryland Physicians Care website (2020a), healthcare services delivery is a priority to HealthChoice enrollees of Maryland under the Maryland physicians’ care. It offers preventive and wellness programs. Additionally, the recipients of the HealthChoice gain services and health care benefits that are valuable at no cost. They include doctor visits, dental care for adults, prescription drug benefits, immunizations, medical care coordination, urgent and emergency care, lab tests, screenings, X- rays, and ‘No copays’ for over the counter prescriptions.

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Costs versus Benefits

Some of the costs versus benefits of the Maryland Physicians are detailed as follows. For members, the health benefits of Maryland Physicians Care are available free of charge at no cost. Such include No pharmacy Copays where over the counter medications and payments are conducted free of charge. Also, there is one free vision care for adults every year. This vision visit is inclusive of one set of contact lenses or a pair of glasses every year. For children, it includes a free eye exam every year with a pair of glasses. When medically necessary, a set of contact lenses is issued. MPC members are not subject to financial liability (Maryland Physicians care, 2020a). Financial plans include deductibles, co-insurance, or costs varying from the formulary for services covered during Healthchoice enrollment. The deciding factor for the estimated pricing of the pharmacies is always the plan design. Such a system may vary with individual copayments and medication pricing. The doctor’s instructions, pharmacists’ judgment, and applicable law may influence costs arising outside prescription.

Services of primary care Physician

Maryland Physicians Care (2020d) argues that the primary care physician’s services include vision care, dental care, free safe link cell phone, behavioral health, and access to a doctor through an app such as myvirtualmpc app, among others. For one’s family, it is possible to choose more than one PCP. There is a wide range of specialists and primary care doctors. The average wait time for one to get an appointment with the chosen PCP is usually about 48 hours. But if the situation is urgent, one can visit an urgent care clinic. In case one needs to cancel the appointment, they can do that within 24-hours advance time. In case one needs a specialist, the PCP or doctor will refer them to the best suited professional. A person can consistently see one PCP. If there is a need to change the PCP, the member needs to make a phone call requesting the change. A client is issued a new ID card after ten days of placing an order (Maryland Physicians Care, 2020d).

Prescription drug benefits

Approved drugs come in a wide range for the doctor’s choice. The list includes both brand name drugs and generic prescription drugs. It is advisable to request the doctor for generic prescription drugs to cover medical needs if they are available.

Provider network and Geographic service area

Maryland Physicians Care provider has a list of hospitals, physicians, and healthcare providers available to its members. Members can locate their location by directly searching on their website or making a call to website contacts. The grouping is according to geographic location. The available information includes the medical facility, the medical professionals, and medical and pharmacy supplies in the locality. For example, the Maryland Physicians Care (2020b) has a clinic – ALDERMAN SPEECH PATHOLOGY on Pennsylvania Avenue, Baltimore, MD 21217. They also provide information on whether it is open at the moment and if new patients are accepted.

Commitment to quality of care and service

According to Maryland Physician Care (2020c), there is a quality management program in place by Maryland Physicians Care. The quality management program assesses and monitors the delivery of healthcare services to the members. It has a priority to ensure that high-quality care and services reach all members. They carry out this by measuring goals-against progress in all quality management program parts, including services and clinical activities like the quality of care evaluation on services offered to members. Also, they establish clinical practice guidelines and preventive health guidelines to ensure that members understand services offered and how often they are required. MPC ensures that the providers have Healthcare Effectiveness Data and Information Set (HEDIS) Tip sheets that reflect NCQA HEDIS specifications. These act as references since MPC is NCQA accredited.

Customer satisfaction

To measure member satisfaction, Maryland physician Care carries out member satisfaction surveys. Moreover, they set out goals that they use to gauge if they have been reached. From Maryland Physician Care (2020c) website, HEDIS tip sheets are references used by the providers to act as a guide to ensure customer satisfaction.

Limitations maximums and exclusions

There exist limitations, maximums, and exclusions with Maryland Physicians Care. Some of them include dental care and a limited number of X – rays conducted during the year. Additionally, with cavity fillings, some of the costs may be incurred by the member (Maryland Physicians Care, 2020c).

Reference

Maryland Physician Care (2020a). Benefits: Your healthcare benefits. Retrieved September 30, 2020, from https://www.marylandphysicianscare.com/for-members/benefits.html

Maryland Physician Care (2020b). Approved Drug Benefits. Retrieved September 30, 2020, from

https://www.marylandphysicianscare.com/for-members/benefits/approved-drug-benefits.html

Maryland Physician Care (2020c). Quality Improvements. Retrieved September 30, 2020, from

https://www.marylandphysicianscare.com/for-members/benefits/quality-improvement.html

Maryland Physician Care (2020d). Seeing a Specialist. Retrieved September 30, 2020, from

https://www.marylandphysicianscare.com/for-members/benefits/specialist.html

Instructions

3pgs, 2 srcs, APA
Assume you are a Maryland resident and Medicaid recipient looking to
enroll in a managed care plan, review the Maryland Managed Care
Website(s) at:

https://mmcp.health.maryland.gov/healthchoice/Pages/HealthChoice-Enrollment.aspx

https://mmcp.health.maryland.gov/healthchoice/pages/home.aspx

Assess and evaluate HealthChoice, Maryland’s statewide mandatory
managed care program based on the following evaluation criteria.
Please choose one (1) of the MCO’s under HealthChoice to evaluate
(e.g., Maryland Physician’s Care).

Answer the questions (using a narrative format) Please be sure to
include a reference page.
……………………………………………………………………………………………………………………………………………………………………………………
HealthChoice/Maryland Managed Care Plan: ?

1. Benefits Offered and Services Covered
(You want a plan that offers a comprehensive benefits package
including preventive care as well as treatment programs for chronic
disease management. Also, you may need emergency care and/or care away
from home. What questions would you ask to determine the benefits and
covered services offered? Evaluate the HealthChoice plan and summarize
your findings.)

2. Cost vs. Benefits
(Managed care plans vary widely in the cost of services offered. It
may be tempting to base your selection primarily on the periodic,
out-of-pocket costs to you. You can’t be sure that the least expensive
plan will give you all the medical services you need. Review cost vs.
benefits for the HealthChoice plan carefully and summarize your
findings.)

3. Services of the Primary Care Physician
(Choosing your primary care physician (PCP) may be the most important
decision you make when enrolling in a managed care plan. The following
questions are important when choosing your plan: Please answer each
question.

Can you choose more than one PCP for your family?
Is there a large choice of primary care doctors and specialists?
How long is the average wait to get an appointment with the chosen PCP?
Can you see the same doctor consistently?
When and how can you change doctors if you are dissatisfied
How does HealthChoice measure up?)

4. Prescription Drug Benefits
(When evaluating a health plan it is very important to know what kind
of prescription drug benefits the plan offers. Depending upon the
plan, there are several systems that have been implemented in efforts
to control costs. Some plans offer a “generic only” plan. What
prescription drug benefits does HealthChoice offer? Are they
beneficial to your current drug regimen?)

5. Provider Network and Geographic Service Area
(Be sure you inquire from the Provider Membership Directory which
providers are included in the network and where they are located in
your community. If you live in one community and work in another;
determine if routine care can be received in either location. Does
HealthChoice have a strong network of Providers in a geographic area
that is amenable to you? Must you go to different locations for
different services? If you have a child away at school, does the
network extend to that area?)

6. Commitment to Quality of Care and Service
(What measures of quality care and satisfaction of service are
available? It is worthwhile to find out if the plan has been
accredited by the National Committee for Quality Assurance (NCQA).
NCQA is the most common accrediting body for network plans. Review and
report on what measures of quality care and satisfaction are available
for HealthChoice.)

7. Customer Satisfaction
(How do enrolled members feel about the plan? There are various
objective forms of measurement used to determine “quality services”
given by managed care plans such as accreditation, HMO report cards
and/or publications produced by the industry. You would be wise to
look at any that measure customer satisfaction. The National Committee
for Quality Assurance (NCQA) mission is to provide information that
enables purchasers and consumers of managed health care to compare
plans based on quality. Their web site may be reached at
http://www.ncqa.org/ )

8. Limitations, Maximums, or Exclusions
(Lifetime Cap refers to the maximum dollar amount of benefits
available to a consumer in a managed care plan during his or her
lifetime. This amount becomes important when confronted with a
life-threatening disease or accident that requires prolonged care
involving expensive therapeutic intervention and support. Does
HealthChoice outline limitations, maximums, or exclusions?)