HMO Strategies and Recommendations

You are the chief executive officer of Southside HMO, which serves 495,000 members throughout the eastern region of the United States. It has come to your attention that several members or patients who participate in your plan have filed a complaint that your HMO plan does not provide quality healthcare delivery. Several patients have been denied healthcare services to see specialists to whom they were referred by their primary care providers.

The board of directors has asked that you provide a 750-word report detailing your strategies and recommendations to investigate the complaints and to identify strategies to ensure that quality management initiatives are in place to make sure that quality healthcare services are provided to all members. The strategies and recommendations should be as specific as possible and include the resources needed for implementation. A minimum of three references are required for this assignment

Three Insights from people in the organization:

Physician – “I have been providing healthcare to patients at Sunnyside Hospital for 5 years, and the hospital recently started contracting in network with Southside HMO. Southside is denying referrals to specialists for care”

Patient Advocate – “I represent patients at Sunnyside Hospital, and more than 30 patients have informed me that Southside HMO is not complying with primary care referrals to specialists for care.”

CEO of Southside HMO – “I have been the CEO of Southside HMO for 10 years, and I ensure that our organization is in compliance with all quality management initiatives.”

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