This is the book and the questions are attached as well Nursing Assignment Help

This is the book and the questions are attached as well

Kongstvedt, Essentials of Managed Care, Sixth Edition ISBN: 978-1-4496-5331-6 

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

Discuss the principle elements of control found in each type of managed care plan. In which plans do those elements appear?

Discuss the primary strengths and advantages; and weaknesses and disadvantages of each type of managed care plan.

Based on Chapter 4:  The Provider Network

Describe a typical physician credentialing process, indicating which steps are required and why they are required. Discuss possible problems that may arise for any steps that are not completed.

Based on Chapter 5:  Provider Payment

Discuss the main forms of facility payment, differentiating inpatient and ambulatory, and the impact of outliers and carve-outs.

Based on Chapter  7:  Basic Utilization and Case Management

Discuss the key attributes of managing basic medical-surgical utilization in different types of managed care plans.

Describe the differences between case management and UM.

Based on Chapter  9:  Physician Practice Behavior and Managed Health Care

Discuss the reasons for an increased interest in managing physician practice behavior.

Based on Chapter 10:  Data Analysis and Provider Profiling in Health Plans

Discuss the most common technical, clinical, and organizational problems medical directors face in using data to manage utilization, and what steps might be taken to deal with those problems.

Based on Chapter 14: Quality Management in Managed Health Care

Describe the strategies an MCO can use to involve physicians in managed care processes.

Share This Post


Order a Similar Paper and get 15% Discount on your First Order

Related Questions

Technology for Patient Safety in Saudi Arabia Paper Nursing Assignment Help

You are the manager of a busy hospital unit.  Your unit has been tasked with selecting and implementing upgraded technology on your hospital unit.  As the unit manger, address the following in your selection of technology and implementation plan: Examine the features of the new technology that are important in

WU Detail and Dynamic Complexity Discussion Nursing Assignment Help

Are you overwhelmed by complexity? If so, you are not alone. Peter Senge notes that people are now able to “create far more information that anyone can absorb,” and he continues to say that the “scale of complexity is without precedent” (2006, p. 69). This “detail” complexity can make managing

Pediatric Health & Medical Worksheet Nursing Assignment Help

Provider: i. Questions for HPI When did these symptoms begin? Is the child experience exercise intolerance? Any shortness of breath/signs of respiratory distress? History of genetic conditions? ii. Questions for ROS Poor feeding? Any newborn cardiac concerns? Previous cardiac history? Any pain, weakness, coldness to the extremities? Fluid retention? Cough

Health & Medical Capital Budgeting at Cleveland Clinic Nursing Assignment Help

Respond to each of the following prompts or questions: Using the information provided in the Los Reyes Hospital case study from Module Three, what capital expenditures may the selected departments need to budget? Considering the organization you selected, what is a capital expenditure that may be needed that would result

NVCC Service Implementation and Elements of Financial Nursing Assignment Help

Instructions: Part 1 1.Read Chapter 10, Capko. -Critique either Dr. Grainger’s or Mid-South Pulmomary Specialists efforts in developing  new services. -What lessons did you learn as related to new service development?   -List three main items which you must address before implementing a new service.  Instructions: Part 2 -The physicians

Healthcare is reimbursed in a variety of ways. The Nursing Assignment Help

Healthcare is reimbursed in a variety of ways. The prospective payment method is one of those ways. This paper will be about the prospective payment method where diagnosis-related groupings (DRGs) forms the basis for payment. Research and explain the origin, purpose, and description of DRGs. Include what payment is based on.

NUR 630 FIU Impact on Healthcare Systems and Public Health Nursing Assignment Help

Autism Spectrum Disorder, Intellectual Disabilities, or Childhood-Onset Schizophrenia In recent years, there have been reports linking autism to vaccinations. After studying Module 5: Lecture Materials & Resources, address the following in a well-written discussion post: Explain the controversy regarding vaccines as a possible cause of autism spectrum disorder. Does the

FIU Ambiguity and Doubts About Managing ASD Reflection Nursing Assignment Help

Autism Spectrum Disorder, Intellectual Disabilities, and Childhood-Onset Schizophrenia After studying Module 5: Lecture Materials & Resources, discuss the following: Reflect on your experience creating a treatment plan for a toddler, school-aged child, or adolescent with autism or an intellectual disability.  Describe the clinical situation in detail.  (Who was it, when