Week#1-To Do List-SMHS

 

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.

Week#1-Quiz

This quiz contains 8 questions. The questions consist of multiple choice, true/false and short answers.  You have 60 minutes in which to complete and submit your answers.

 

Week 1: Key Terms

Utilization management

Quality management

Data warehousing

Validity

Reliability

Provider profiling

Risk adjustment

Pharmacy benefit managers

Drug utilization review programs

Pharmacogenomics

Parity

Density

Credentialing

Readings

Please use the above course book to read the following sections:

Part I: Introduction to Health Insurance and Managed Health Care

Chapter 1: A History of Managed Health Care and Health Insurance in the United States

Chapter 2: Types of Health Insurers, Managed Health Care Organizations, and Integrated Health Care Delivery Systems

Chapter 3: Elements of the Management and Governance Structure

Part II: Network Contracting and Provider Payment

Chapter 4: The Provider Network

Chapter 5: Provider Payment

Chapter 6: Legal Issues in Provider Contracting

Chapter 7: Basic Utilization and Case Management

Chapter 8: Fundamentals and Core Competencies of Disease Management

 

Internet: Managed Care: The U.S. Experience(will attach)

 

***Do you have access to this text?***

Essentials of Managed Health Care, 6th Ed.

Peter R. Kongstvedt

Jones& Bartlett Learning, LLC