Managed care

7. Managed care seeks to control health care costs through controls on price, demand, and supply. Describe at least 5 common strategies by which it does this. Include some discussion of each to at least identify the mechanism and intent of the strategy. Health Maintenance Organizations (HMOs) A member of HMO is required to pick a primary care physician as a gate keeper to coordinate all services. The chosen primary care physician will also be the person who refers a member to another…

1. Briefly describe the Medicare program (who in general is covered/ eligible and the basic structure of the program- the parts & what overall each covers). Medicare (Title 18) is a program that provides health care to individuals who are 65 years or older, disabled, or individuals with fatal kidney failure. A basic four-part structure is used to construct the foundation of Medicare, Part A: hospital insurance, Part B: supplementary medical insurance, Part C: Medicare advantage, Part D:…

reimbursements, impact of Managed Care, and hospital closures would lead to the maid forces responsible for hospital downsizing. Hospital reimbursements had the most dramatic affect on hospital utilization…

the proper care. This will help avert burden in the health care system such as redundant medical procedures or ineffective treatments that prolongs the client’s hospital stay. There are five ways that case managers can improve the hospital’s performance: improving the outcomes, reduction of readmissions, eliminate avoidable day, enhancing claims management and boosting the core competencies (Fink-Samnick, Owen, & Rasmussen, 2013). Case managers play a vital role in the health care systems…

writing will discover the different types of healthcare systems there are around the US. Health care provides services diagnose and treat patients in a hospital environment in the The United States has the biggest healthcare market around the world. I will also be discussing the different types of healthcare people receive like PPO and HMO and what the differences are between these two health care plans. PPO is a preferred Provider Organization plan and this is very popular among…

Medicare (Title 18) is a program that provides health care to individuals who are 65 years or older, disabled, or suffer from kidney failure. Medicare has a basic four-part structure: Part A, which is hospital insurance, Part B, which is supplementary medical insurance, Part C, which is Medicare advantage, and Part D, which is prescription drug coverage. Part A and B make up what is known as traditional Medicare. Part A concerns hospital insurance, this is financed by payroll taxed through…

nation’s largest patient-centered medical home (PCMH) designation program. The major goals of the program are to better manage patient care, reduce unnecessary tests, avoid unneccesary hospital admissions, and avoid emergency department visits. The project focuses on four areas of patient-centered medical home practices: care management, self-management support, care coordination, and linkage to community services. Population Blue Cross Blue Shield of Michigan’s patient centered medical home…

Purchasing (VBP) and its characteristics? Value-based purchasing defined: “a system in which purchasers hold providers of health care accountable for both the costs of health care and its quality” (Casto, 2013, p. 276). What I believe to be the characteristics of VBP does the following: collects information on quality with cost data, focuses on reducing inappropriate care, and rewards the best-performing providers (Meyer et al. 1997, n.p.) (Casto, 2013, p. 276). I believe these are the great…

practices based on the definition provided by the Institute of Medicine (IOM), the IOM states that clinical practice guidelines are statements that contain recommendations to enhance patient care that are composed by a systematic review of evidence and an assessment of the benefits and harm of alternative care options. JFCS Quality Management and Clinical Management actively work with staff to ensure the proper delivery of treatment according to their respective programs. The goals and…

The following research paper will discuss the following topics of access to healthcare, preventive care, and utilization of services available to the population of the United States throughout their life span. Access to healthcare in the United States is an important topic being discussed in the medical arena today. Hospitals, clinics, and emergency centers are showing everywhere in the larger communities. So what is the problem with access? It begins with the ability to pay (obtain insurance…