Overview of The Medicare Advantage Program Assignment
Overview of The Medicare Advantage Program Assignment
Program/policy evaluation is a valuable tool that can help strengthen the quality of programs/policies and improve outcomes for the populations they serve. Program/policy evaluation answers basic questions about program/policy effectiveness. It involves collecting and analyzing information about program/policy activities, characteristics, and outcomes. This information can be used to ultimately improve program services or policy initiatives.
Nurses can play a very important role assessing program/policy evaluation for the same reasons that they can be so important to program/policy design. Nurses bring expertise and patient advocacy that can add significant insight and impact. In this Assignment, you will practice applying this expertise and insight by selecting an existing healthcare program or policy evaluation and reflecting on the criteria used to measure the effectiveness of the program/policy. Overview of The Medicare Advantage Program Assignment
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RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
To Prepare:
Review the Healthcare Program/Policy Evaluation Analysis Template provided in the Resources.
Select an existing healthcare program or policy evaluation or choose one of interest to you.
Review community, state, or federal policy evaluation and reflect on the criteria used to measure the effectiveness of the program or policy described. Overview of The Medicare Advantage Program Assignment
The Assignment: (2–3 pages)
Based on the program or policy evaluation you selected, complete the Healthcare Program/Policy Evaluation Analysis Template. Be sure to address the following:
Describe the healthcare program or policy outcomes.
How was the success of the program or policy measured?
How many people were reached by the program or policy selected?
How much of an impact was realized with the program or policy selected?
At what point in program implementation was the program or policy evaluation conducted?
What data was used to conduct the program or policy evaluation?
What specific information on unintended consequences was identified?
What stakeholders were identified in the evaluation of the program or policy? Who would benefit most from the results and reporting of the program or policy evaluation? Be specific and provide examples.
Did the program or policy meet the original intent and objectives? Why or why not?
Would you recommend implementing this program or policy in your place of work? Why or why not?
Identify at least two ways that you, as a nurse advocate, could become involved in evaluating a program or policy after 1 year of implementation.
Healthcare Program/Policy Evaluation Analysis Template
Use this document to complete the Module 5 Assessment Assessing a Healthcare Program/Policy Evaluation
| Healthcare Program/Policy Evaluation | Medicare Advantage (MA) Program |
| Description | Medicare participants have access to the Medicare Advantage (MA) program as a managed care option. Beneficiaries of the program have access to private insurance policies that cover prescription drugs and hospital stays, as well as extras like vision, dental, and hearing coverage (Willink et al., 2020).
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| How was the success of the program or policy measured?
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A number of variables, including enrollment rates, cost savings, healthcare quality, and beneficiary satisfaction, were used to assess the MA program’s effectiveness (Park et al., 2020). The effectiveness of the program was also assessed in terms of how it affected aspects of health, like hospitalization rates and illness management. Overview of The Medicare Advantage Program Assignment
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| How many people were reached by the program or policy selected? How much of an impact was realized with the program or policy selected?
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As of 2021, there were over 26 million Medicare beneficiaries in the MA program. The initiative has been successful in giving participants access to extra benefits such as programs for managing chronic diseases and prescription drug coverage. Additionally, it has assisted in lowering healthcare expenses for both recipients and the federal government.
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| At what point in program implementation was the program or policy evaluation conducted?
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Since the MA program’s introduction in 1997, it has undergone frequent evaluations. The effectiveness of the program on healthcare expenditures, the standard of care, and beneficiary satisfaction are evaluated on an annual basis (Gomez, 2020).
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| What data was used to conduct the program or policy evaluation?
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Beneficiary health outcomes, claims data, plan ratings, surveys, and cost analyses are among the data used to assess the MA program. The success of the program in enhancing health outcomes and lowering healthcare expenditures is assessed using these data sources.
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| What specific information on unintended consequences were identified?
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Limited provider access, a wide range of plan benefits and prices, and significant inequalities in care quality between MA plans and regular Medicare are all unintended outcomes of the MA program. Additionally, some beneficiaries might find it challenging to select a plan that addresses their specific healthcare requirements.
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| What stakeholders were identified in the evaluation of the program or policy? Who would benefit most from the results and reporting of the program or policy evaluation? Be specific and provide examples. Overview of The Medicare Advantage Program Assignment
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The MA program is being evaluated by a variety of stakeholders, including legislators, healthcare professionals, insurance providers, and beneficiaries. The main stakeholders who gain from the program’s extra advantages and lower healthcare expenses are the beneficiaries. Increased enrollment and revenue are also advantageous to insurance firms.
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| Did the program or policy meet the original intent and objectives? Why or why not?
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The MA program’s original goals of giving participants more benefits, cutting healthcare costs, and enhancing healthcare outcomes have all been achieved. The program still has issues with maintaining uniform quality of care among plans and providing fair access to care.
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| Would you recommend implementing this program or policy in your place of work? Why or why not?
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As a nurse advocate, I would advise putting the MA program into place at my place of employment to give our Medicare beneficiaries access to more benefits and financial savings. The choice of a plan must nevertheless be carefully considered in order to guarantee that beneficiaries have access to reliable medical services and provider networks.
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| Identify at least two ways that you, as a nurse advocate, could become involved in evaluating a program or policy after one year of implementation.
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After a year of implementation, as a nurse advocate, I could participate in the MA program’s evaluation in the following ways:
Surveying beneficiaries to determine how happy they are with their MA plan and to pinpoint areas for improvement.
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| General Notes/Comments | A well-liked managed care alternative for Medicare recipients that offers extra benefits above and beyond standard Medicare coverage is the Medicare Advantage (MA) program. Beneficiaries can select from a variety of plan alternatives under the program, which is provided by private insurance firms, to fit their healthcare needs. Supporters of the program contend that it increases options and improves access to care while encouraging cost savings, but detractors have expressed worries about potential restrictions on access to care and the standard of care offered by private insurers. In order to make sure that the program is fulfilling the needs of Medicare beneficiaries and delivering high-quality treatment, nurses and other healthcare professionals can play a significant role in evaluating and enhancing it. Overview of The Medicare Advantage Program Assignment
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References
Gomez, M. (2020). Medicare Advantage with Care Coordination Programs (Doctoral dissertation, California State University, Northridge).
http://scholarworks.csun.edu/bitstream/handle/10211.3/217394/Gomez-Maria-thesis-2020.pdf?sequence=1
Park, S., Larson, E. B., Fishman, P., White, L., & Coe, N. B. (2020). Differences in health care utilization, process of diabetes care, care satisfaction, and health status in patients with diabetes in Medicare Advantage vs traditional Medicare. Medical care, 58(11), 1004.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7572707/
Willink, A., Reed, N. S., Swenor, B., Leinbach, L., DuGoff, E. H., & Davis, K. (2020). Dental, Vision, And Hearing Services: Access, Spending, And Coverage For Medicare Beneficiaries: The role Medicare Advantage plans play in providing dental, vision, and hearing services to older adults, particularly among low-and middle-income beneficiaries. Health Affairs, 39(2), 297-304.
https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2019.00451 Overview of The Medicare Advantage Program Assignment