Disscussion-1

We have seen that the U.S. health care system evolve, and bring about changes that have both been a blessing to some, and a curse.  Discuss the salient forces leading to the rise and fall of various types of managed care plans. Speculate on how current and future forces might lead to further changes.

Discussion-2

Discuss how disease management falls short, with regard to the entire spectrum of care management.  Provide at least two examples to support your discussion.

Research Paper

Select an area of managed care of interest, and be prepared to submit an abstract during week three.  In selecting your topic, be sure that it is something that you have a genuine interest in, as you will further develop this into a thorough research paper that you will submit during week seven.   The focus of your research should include the history of your selected topic, how it has evolved, contributions made to managed care efforts, and future forecasts of its sustainability.

Quiz -

1. The integral components of managed care are:

A. Wellness and Prevention

B. Primary care orientation

C. Utilization management

D. A & C only

E. All of the above

2. Capitation is usually defined as

A. Prepayment for services on a fixed, per member per month basis

B. Performance based compensation system

C. Fee-for-service including withhold provisions

D. Stop-loss reinsurance provisions

3. Ancillary services are broadly divided into the following categories:

A. Pharmacy and diagnostic

B. Laboratory and therapeutic

C. Diagnostic and therapeutic

D. Pharmacy and radiology

4. Which of the following forms of hospital payment contain no elements of risk sharing by the hospital?

A. Capitation

B. DRGs and MS-DRGs

C. Per diem

D. Sliding scale FFS

E. C and D

5. Which of the following is NOT true for the purposes of "letter of intent"?

A. It is a preliminary understanding between two parties

B. It is used most often when the negotiation process is expected to be lengthy

C. It is a contemplated arrangement between two parties

D. It is a legally binding agreement

6. The use of utilization guidelines targets only managed care patients and does not have an impact on the care of non-managed care patients. T/F?

7. Describe the goal of disease management.

8. Briefly discuss three methods used to manage utilization during the course of a hospitalization.

Attachment:- Reading.rar