MH684 Activity 1: Overview of Managed Care
Blue cross blue shield association (BCBSA) consists of 26 independent and locally-operated health insurance companies. Blue Cross was created in 1929 to provide prepaid hospital care, and Blue Shield was established approximately a decade later to provide reimbursement for physician services. These separate entities merged in 1982 to form the BCBSA we know today. It comprised of publicly traded companies, such as Anthem, multi-state private companies, such as the Health Care Service Corporation and Highmark, and single-state or regional companies. BCBSA also operates health plans outside of the United States. The BCBSA has experience offering health insurance coverage options of all kinds including individual and group insurance, and also administers government entitlement programs, such as Medicare and Medicaid. Its health plans have come in many different forms, including health maintenance organizations (HMOs), preferred provider organizations (PPOs), point-of-service (POS) and consumer directed health plans (CDHPs), among others. A CDHP is a special form of a high deductible health plan coupled with a health saving account (HSA) to help individuals manage health care expenditures. BCBSA continues to grow and currently provides insurance coverage to nearly one out of every three Americans.
1. Describe the difference between individual and group insurance.
2. Describe the difference between Medicare and Medicaid, including who can qualify for coverage under each program.
3. Describe the difference between an HMO, PPO, POS and CDHP.
4. Describe an HSA, including how it can be used to manage personal health care expenditures.
