MANAGED HEALTH CARE

Instructions: Your final class assignment will consist of an essay responding to the five (5) questions enumerated below. You are asked to answer each question completely, using correct grammar and sentence structure. Please do not simply copy and “paste everything”, from your text- think about your answers. Questions 1-4 must be answered in a minimum of two paragraphs. Question 5 will be completed as you deem needed. As we all wish to maintain the highest level of educational integrity, this is an individual’s assignment. We encourage students to interrelate through dialogue, learning and comradery. However, any answers to questions that are or appear to be deliberately the same from one student to another will be graded poorly. I know that this will not happen as I have the highest respect for each of you. However, it is important to be clear. Strive for good work and you will yield a good grade.
1. Managed Health Care has significantly affected the Health Care Delivery system in the United States. In your own words, describe Managed Health Care. What were some of the factors that influenced its development, and describe the advantages and disadvantages of managed care from the perspective of the Patient and Provider?

2. Managed Health Care Organizations administer many functions. Payment is a key element. Please describe the difference between Reimbursement and Payment how do these affect provider behavior? Explain risk based versus non-risk based payment methods and provide some examples of each?

3. Managed Health Care manages several components which include medical services, costs and quality of care. Describe utilization review, its purpose and three utilization methods and functions employed by managed care organizations. Describe Case management and Disease management, compare by providing some examples of each.

4. A Managed Care payer organization uses several managerial and operational functions to accomplish its goals. Describe the difference between Governance and Management and provide examples of each. Describe the difference between sales and marketing and provide some examples of each.

5. What would you say are the are the four most important lessons you have learned about managed care?

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