Introduction To SWOT-EFE In Medicare Or Medicaid Services
When an organization performs a SWOT analysis it allows the organization to take an overall look at factors that could have a positive or negative impact on the organization’s strategic goals. The purpose of an organization performing a SWOT analysis is to aid the organization in focusing on an area that has the potential to produce the best benefits. After taking into consideration the quality, room for improvement, and dangers toward the Centers for Medicare and Medicaid Services, there are a considerable number of the things which contribute as the outside components can influence the ways of providing Medicare or Medicaid services to beneficiaries. This would also possibly change what services are covered and what is denied. Many private insurance companies are working closely with Medicare to offer advantage plans, or to provide Medicaid policies through their companies as well.
By teaming up with private insurance plans Medicare benefits by being able to collect premiums while providing quality insurance options to more members. The more members that they have the more services they can cover with those revenues. However, if a member finds the private insurance policy more beneficial they may shy away from Medicare and purchase insurance through the private company instead. Medicare does not include pharmacracy benefit unless purchased separately. With these alternatives available Medicare would lose revenue due to members not paying into their premiums, deductibles, or coinsurances. Lack of members would be lack of more government funding. Higher taxes or higher premiums generally would be the way to fix such budget issues to assure CMS stays functioning.
Private insurances have grown significantly since the Affordable Health Care Act has been enforces. With this being the case, many other private insurance companies have come into the healthcare industry to offer competitive rates which unlike Medicare and Medicaid do not go off age or disability status. For many providers it is easier to become contracted with Medicare and Medicaid since their cliental is so large and all over the United States, meaning more clients need their services. However, it come down to whether those patients have Medicare or Medicaid for insurance.
For now, other insurance companies are a threat, but in the future, they may be needed as population goes up. There are more low income, elderly, and disabled individuals needing coverage causing an increased strain on Medicare and Medicaid financially. The more insured people, the more staff members are needed to manage such policies, the more it costs for the business to run. If CMS did not have funding to provide these services to individuals, they would go without healthcare and it would put a damper on how these individuals function in society.
Many people who do not actually need these services, such as those who are not truthful about their income situations to receive benefits are a large threat to CMS since they are paying to cover services for those whom should be able to afford to pay for their insurance out of pocket like the others in their income bracket. Continuing to raise the income guidelines would weed out some of those who no longer qualify for those services. Making the application process more specific and requiring more proof of financial instability would help as well. These services should not be abused and should not be taken from those who are in need, but the system needs to be stricter against those who abuse the system and receive benefits they do not need.
