generate,
designate, Organize, investigate and, present a Manage Care Control
Cost Plan: Under traditional indemnity insurance, the money follows the
patient. Patients select health care providers and visit them as they
choose. Providers then bill the private insurer or public payer and are
reimbursed on a fee-for-service or per case basis
. Introduction (30%)
Provide a short-lived outline of the meaning (not a description) of Chapter 9
and 10 and articles you read, in your own words. Types and classifications of
managed care models.
2. Manage Care
Control Cost Plan: (50%)
a. Cost savings
‘‘Structural changes centered around the expansion of
managed care have been the major transformative force in health markets in
recent years and have played a major role in restraining growth in health
spending’’
b. Provider
reimbursement
This complaint has two dimensions: hospital profitability,
and physician compensation. As far as hospitals are concerned, administrators
are worried about profitability or surplus for reinvestment, and consumers are
worried about the threat of hospital closures. Few things stir as much public
outcry as the prospect of closing a community hospital.
c. Quality of care
Much recent legislation and many legal reforms havebeen aimed at preventing managed care’s
perceivedquality abuses. The
Patient Bill of Rights, which hasbeen
heavily debated in Congress, defines, amongother things, the rights of consumers with complexconditions to access directly a qualified specialist,continuity of provider for patients
who are underregular treatment, and
self-referral to certain types ofspecialists.
3. Conclusion (20%)
Quickly recapitulate
your thoughts & statement to your critique of the articles and Chapter you
read. How did these articles and
Chapters impact your thoughts about Manage Care? What did you learn about manage care and how
you will apply all these knowledge?
Evaluation will be based on how clearly you respond to the
above, in particular:
a) The precision with which you analyses the articles;
b) The complexity, possibility, and organization of your
paper; and,
c) Your conclusions, including a description of the impact
of these articles and Chapters on any Health Care Setting.
Expert Solution Preview
Introduction:
Chapter 9 and 10 and the articles we read in class focused on managed care models and the different types and classifications. The goal was to understand how managed care can control healthcare costs, improve the quality of care provided, and impact provider reimbursement.
1. Provide a Manage Care Control Cost Plan:
a. Cost savings:
The implementation of managed care has played a significant role in restraining growth in health spending. Managed care models allow for more affordable health coverage options, resulting in cost savings for both consumers and insurers.
b. Provider reimbursement:
The transition to managed care can cause concerns regarding hospital profitability and physician compensation. Hospital administrators can worry about profitability or surplus for reinvestment, while consumers worry about the threat of hospital closures.
c. Quality of care:
Recent legislation has been aimed at preventing managed care’s perceived quality abuses. The Patient Bill of Rights defines the rights of consumers with complex conditions to access directly a qualified specialist, continuity of provider for patients who are under regular treatment, and self-referral to certain types of specialists.
2. Conclusion:
After analyzing the articles and chapters on managed care, my understanding is that it can serve as an effective strategy for controlling healthcare costs while simultaneously improving the quality of care provided to patients. Additionally, I have learned that proper implementation and regulation are crucial to prevent any potential issues regarding provider reimbursement and quality of care.
In conclusion, as we move towards a more value-based healthcare system, managed care models will be increasingly relevant, and it is essential to have a comprehensive understanding of their implications. Through the knowledge gained in this course, I will apply what I have learned in my teaching and research to help prepare future healthcare leaders to navigate this complex landscape effectively.
