spacenab

Spacenab

Log in

 Password
"Post your contents, writings, articles, info-graphics, and more on spacenab."
sign up with facebook
Create a new post
Rabbit

HSM546 Health Ins and Managed Care Keller

Rabbit

HSM546 Health Ins and Managed Care Keller

 

Buy from here:

 

 http://hwminute.com/downloads/hsm546-health-ins-and-managed-care-keller/

 

HSM 546 Week 1 DQ 1 HMO Formation

HSM 546 Week 1 DQ 2 Managed-Care Plans

HSM 546 Week 1 Quiz

HSM 546 Week 2 DQ 1 Utilization Management

HSM 546 Week 2 DQ 2 The Effect of Human Behavior

HSM 546 Week 2 HSM 546 You Decide Cooper-Pearson Sports Marketing

HSM 546 Week 3 DQ 1 Payment Mechanisms

HSM 546 Week 3 DQ 2 Managed-Care Underwriting

HSM 546 Week 3 Quiz

HSM 546 Week 4 DQ 1 Consumer Strategy

HSM 546 Week 4 DQ 2 Claims and Benefit Administration

HSM 546 Week 4 Managed Care Enrollment

HSM 546 Week 5 DQ 1 Social Insurance Medicaid

HSM 546 Week 5 DQ 2 Social Insurance Medicare

HSM 546 Week 5 Quiz

HSM 546 Week 6 DQ 1 The Regulatory Environment and Quality in Managed Care

HSM 546 Week 6 DQ 2 The Quality of Healthcare

HSM 546 Week 6 Executive Summary Article Review

HSM 546 Week 7 DQ 1 Issues Driving Federal Policy

HSM 546 Week 7 DQ 2 The Impact of Technology

 

 

 

HSM 546 Week 1 Quiz

 

Detailed Product Description

1.

Question :

(TCO B) The integral components of managed care are _____.

Student Answer:

wellness and prevention

primary-care orientation

utilization management

wellness, prevention, and utilization management

All of the above

 

 

2.

Question :

(TCO A) Which organization(s) need a corporate compliance officer (CCO)?

Student Answer:

Health plans with a MedicareAdvantage risk contract

Every organization that provides healthcare.

Hospitals

All of the above

Health plans with a MedicareAdvantage risk contract and hospitals

 

 

3.

Question :

(TCO A) Basic elements of credentialing include _____.

Student Answer:

hospital privileges

malpractice history

medical license

continuing medical education (CME)

All of the above

 

 

4.

Question :

(TCO B) When selecting a hospital during the network-development phase, an MCO considers the _____.

Student Answer:

occupancy rate

cost of services

scope of services

All of the above

occupancy rate and the scope of services

5.

Question :

(TCO B) Common areas of clinical focus subject to hospital P4P programs include _____.

Student Answer:

community acquired pneumonia

congestive heart failure

acute myocardial infarction

prevention

community acquired pneumonia, congestive heart failure, and acute myocardial infarction only

HSM 546 Week 2 You Decide

Product Description

Scenario Summary:Cooper-Pearson Sports Marketing

Cooper-Pearsonis a very successful sports-marketing company with 75 employees. It has been in existence for 10 years, and it clearly has a bright future. One of the fundamental reasons for Cooper-Pearson’s phenomenal growth has been an investment in selecting the best and brightest men and women from colleges and universities throughout the United States and paying them well. Cooper-Pearson Sports Marketing has noticed that, in the past 2 years, 15 key senior employees have left the firm. Many of these men and women have joined Always on the Ball Sports Marketing Company, a competitor of Cooper-Pearson. During the exit interviews, one of the reasons that was consistently mentioned as a reason for leaving was the lack of adequate or affordable medical insurance.

 

Cooper-Pearson Sports Marketing managers have come to understand that a competitive compensation package must include medical benefits that employees want and can afford. They also understand that medical insurance has become an important recruitment tool in attracting quality employees. Like the company, quality coverage is extremely important, but so is cost.

Your Role

The company has engaged your services to research several insurance programs. First, compare and contrast the differences between an HMO, a PPO, and an indemnity insurance program. From the list below, select and discuss at least one other important service that Cooper-Pearson should consider when selecting an insurance program.

1. Discuss the importance of managed-care physician credentialing.

2. Explain the benefits of a prescription drug program to the employer and the employee.

3. Explain the importance of quality-management indicators in managed-care programs.

HSM 546 All 7 Weeks Discussions

Product Description

Week 1 dq1 - HMO Formation

Week 1 dq2 - Managed-Care Plans

 

Week 2 dq1 - Utilization Management

Week 2 dq 2 - The Effect of Human Behavior

 

Week 3 dq1 - Payment Mechanisms

Wee 3 dq 2 - Managed-Care Underwriting

 

Week 4 dq1 - Consumer Strategy

Week 4 dq2 - Claims and Benefit Administration

 

Week 5 dq1 - Social Insurance Medicaid

Week 5 dq2 - Social Insurance Medicare

 

Week 6 dq1 - The Regulatory Environment and Quality in Managed Care

Week 6 dq2 - The Quality of Healthcare

 

Week 7 dq1 - Issues Driving Federal Policy

Week 7 dq2 - The Impact of Technology

HSM 546 Week 3 Quiz

Product Description

1.

Question :

(TCO D) Capitation will solve the issue(s) of _____.

high-utilization patterns

poor quality of care

lack of accessibility

All of the above

None of the above

2.

Question :

(TCO D) Which of the following is the leading reason for member complaints?

Student Answer:

Lack of coverage

Enrollment issues, such as a missing ID card

Claims issues

Interactions with the member's PCP

3.

Question :

(TCO D) Discuss how information technology (IT) can make disease-management programs more successful.

Information technology can aid in helping the program by maintain the statistics, schedules, activities for each disease, provide some project management. The technology cn become an essential pat of the by help in monitoring the case time schedules and due dates as well as a quick look at the progress of your project.

Information technology (IT) contributes to disease management (DM) through a number of aspects. The use of data mining to determine patterns of care and the use of predictive modeling are paramount for a successful DM program. Automated decision-support software are also required to enable case managers and others to document interventions, track changes, communicate with other case managers, and have automated access to clinical algorithms. Also, the use of the Internet allows for added means of communication with patients and providers. Automated clinical-sensing devices used by the patient transmit data to DM case managers and allow for better clinical status tracking.

4.

Question :

(TCO D) Which of the following is not necessarily a red flag for case management?

Long hospital length of stay

Expenses beyond a certain threshold

Location of care

Early referral to a specialist

 

 

5.

Question :

(TCO D) Which of the following aspects of the claims capability must be counted or measured in order to allocate adequate resources and verify financial assumptions about an insured population?

Inventory receipts

Timely filing limits

Turnaround time, based on the date the MCO received the claim

Claims lag

IBNR

All of the above

HSM 546 Week 4 Managed Care Enrollment

Product Description

Scenario Summary:Managed Care Plan Enrollment

Atlanta, Georgia has a very diverse work force, consisting of men and women of various ages, ethnic groups, skills, and education. Many people live and work in one of approximately 14 counties that make up the Atlanta region. It is not uncommon for an employee to drive close to 100 miles one way to get to work. The employer base is diverse as well, consisting of large and small employers that range from entrepreneurs; healthcare services; local, state, and federal government offices; information technology; higher education; landscaping; personal services; banking; and the fast-food industry. Now that we have some background information, let's learn more about the ABC Insurance Company located in Atlanta.

 

The ABC Insurance Company has been very aggressive and quite successful in recruiting companies, organizations, and individuals to join its managed care plans. Their ranges of services and rates have been extremely competitive. Their employer base is spread out among the 14 counties, which has been attractive to many employers. The ABC Insurance Company has been quite successful in selling its managed care insurance program to employers and organizations, so what is the issue?

 

Verde Greene Hospital has an excellent reputation for quality in maternity care, cardiac rehabilitation, and orthopedic medicine, and it is the only hospital in town to have received the Magnet Award for Excellence in Nursing. A sizable number of employer groups as well as employees, who have insurance coverage with ABC Insurance Company, want Verde Greene Hospital to be included in the network as a participating hospital.

 

When ABC insurance company approached Verde Greene Hospital to recruit it as a participating provider in their managed care plan, Verde Greene Hospital was very delighted to be asked. In fact, the hospital’s overall response was quite positive. However, there was one contractual stipulation that Verde Greene Hospital needed prior to signing any contracts and becoming a participating provider. Specifically, Verde Greene wanted to be the exclusive provider of maternity and cardiac care for all the patients in the ABC Insurance Company network: no exclusivity, no deal.

 

Because so many employers had pressured ABC Insurance Company to contract with Verde Greene Hospital, the insurance company agreed to the stipulations and agreed to enroll Verde Greene as a participating provider of care and an exclusive provider of cardiac and maternity services. This contract is legally binding for both parties, and they are scheduled to sign this contract in 10 days.

It appears that the exclusivity clause in the contract may have created several unanticipated problems, which are listed below.

It means that patients who needs cardiac or maternity care may need to drive 50 miles and pass four or five other good hospitals in the plan network in order to get the care they need at Verde Greene Hospital. A number of obstetrics and gynecology physicians, as well as cardiologists, who reside in one of the 14 counties do not have privileges at Verde Greene Hospital and have threaten to disenroll from the plan if Verde Greene Hospital is the only hospital contracted to see their patients. Even if these physicians are given hospital privileges, this would mean more staff meetings and Emergency Department duty at a hospital that is too far away. The existing staff physicians at Verde Greene Hospital object to the loss of available hospital space and time, as well as to the possibility of losing existing patients to the new physicians. These physicians also threaten to disenroll from the plan. The other hospitals in the managed care plan object to the loss of patients and have threatened to disenroll from the plan as well and have threatened to sue for restraint of trade.

Your Assignment

What should ABC Insurance Company do? Why? How? What should Verde Greene Hospital do? Why? How? What should the employers do? Why? How? What should the patients do? Why? How?

HSM 546 Week 5 Quiz

Product Description

1.

Question :

(TCO F) Which of the following payment policies addresses the issue of selection bias among Medicare risk plans?

:

ISAR adjustments

Regional benchmarks

Risk adjustment

None of the above

2.

Question :

(TCO F) Which of the following standardized measures for quality of care is commonly used for managed care and Medicare programs?

Student Answer:

HEDIS

TQM

SERVQUOL

QOI

 

 

3.

Question :

(TCO F) Which of the following represents the largest group of persons in the Medicaid program?

Student Answer:

Persons who have low income and minor children

Persons who are economically poor and older

Persons who are in nursing homes or in specialized facilities

Persons who are economically poor and disabled

 

 

4.

Question :

(TCO F) Outcomes of the TRICARE program suggest that _____.

Student Answer:

cost controls are increased

quality is increased

military reports cards are more favorable

All of the above

 

 

5.

Question :

(TCO F) Which of the following has been adopted as the new quality initiative within the military health system?

Student Answer:

TQM

Six Sigma

CQI

Balanced Score Card

HSM 546 Week 6 Executive Summary Article Review

Product Description

HSM 546 Week 6 Executive Summary Article Review

 

Views(16) Opinions(0) 09/05/2016 14:07:21 Report abuse
Copyright © 2014 spacenab.com . All the right reserved.