Assignment 6 Introduction It is essential that health care leaders have the adequate knowledge and data tools available to make informed decisions within the health care industry. Overall‚ managed health care systems rely on the collection‚ analysis‚ and reporting of data to aide in decision making that will affect individuals participating in the managed health care system. Therefore‚ it is essential that informed decisions are made and the health care leaders are educated on the data reports. After
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experience in managed care is important and will be able to use technical and strategic skills to meet the negotiation process. Managed Care Payer Manager Participates in developing the strategic course for acute care hospitals and ancillary care providers in accordance with Company’s and Region’s overall guidance in such areas as delivery system redesign‚ health care reform and strategic pricing and recovery approaches; and for successful operations between Company and Managed Care Organizations
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Long before it was officially called the HMO‚ managed care can be traced back to as early as the 1920s to the mid-1940s. The first example was the Western Clinic in Tacoma‚ Washington‚ it had its own providers and a variety services for a monthly premium payment of $0.50 per member. That later expanded to 20 other sites in Oregon and Washington. That same year a physician‚ Dr. Shadid‚ in Oklahoma‚ established a health cooperative for farmers in small towns who don’t have access to physicians. More
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Some researchers feel that our society has unrealistically demanded the health care system to maximize quality while lowering the costs of health care services. That if we demand this change‚ there is no way we are realistically considering the cost of health care. I understand that everyone wants to receive the best therapy without paying a large amount of money. When you think about this idea‚ this plan would take time to execute. One of the cons of living in a country like the United States is
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Effectiveness Mental health care is something that everyone is affected by‚ whether it is being provided or being needed. Because of its vast reach‚ it is important to have access to mental health care when needed; Providing that care is no simple task. The article ‘The Managed Care Approach to Health Care Blocks Access to Mental Health Treatment’ (2008) uses pathos‚ logos and ethos as methods of persuasion‚ respectively‚ they elicit: emotion‚ logic and authority. Combined in this situation
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profit because a fee-for-service was still the predominant form of payment (Zuckerman‚ 2011‚ p. 6). However‚ during the 1990s many medical facilities faced foreclosure and buyouts because of the rise of the managed care industry (Zuckerman‚ 2011‚ p. 6). More recently‚ the Affordable Health Care Act (ACA) has caused many healthcare organizations to reevaluate their strategic plans and missions statements‚ so that they may survive on making less of a profit while still offering a variety of medical
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Achieving and Maintaining Accreditation in Managed Care Accreditation is a process by which an impartial organization (URAC) will review a company’s operations to ensure that the company is conducting business in a manner consistent with national standards. For a physician and a nurse after they receive their degree they have to do continuing education courses every year to maintain their licensing with that particular state. These classes are generally known as CME’s (Continuing medical education)
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Why were managed care organizations initially hesitant to use data mining applications? One of the biggest hesitations would have to be cost to build an implement such a system. The technique depends on an organization having "clean" data to analyze‚ which requires data being scrubbed and moved to data warehouses. Many payers lack the money and manpower to build and maintain these warehouses. (Kongstvedt‚ P.‚ Capagemini). In addition‚ internal politics and the numerous constituencies within a
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for managed care organizations? Which federal regulations also bring specific requirements for the operation of such entities? Discuss state and federal regulation of MCOs. State oversight of managed care generally focuses on two aspects: the techniques and processes used by a payer‚ and in particular an HMO‚ to deliver or arrange for the delivery of health care services to enrollees‚ and the organizational structure of the payer. (Kongstvedt 596) Much of the state regulation of managed care
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Describe the effects of managed care on physician’s practices. Do you see these effects as positive or negative? Why? Some effects are negatively affecting the care that physicians are able to provide their patients. In some patients are being denied health care coverage for health services by health plan providers because the provider does not believe that a severity of an illness is noticeable. For example: A teen tells his/her physician that they feel suicidal‚ but the mental health patient
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