Ans) Managed care, also called managed health care, type of health insurance and system of delivering health care services that is intended to minimize costs. Managed care is specific to health care in the United States.
- Utilization review: looking at the appropriateness of services provided. ensure that services are delivered, care is affordable and subsequent care is plan. become common because of use of medications.
- Prospective Utilization Review
o Determines the appropriateness of utilization before the care is
actually delivered.
o Example: the decision by a primary care gatekeeper to refer or
not refer a patient to a specialist
o Objective is to prevent unnecessary or inappropriate
institutionalization.
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Concurrent Utilization Review
o Determines, on a daily basis, the length of stay necessary in a
hospital.
o Monitors the use of ancillary services and ensures that the
medical treatment is appropriate and necessary.
o Discharge planning is also accounted for by the utilization
review nurse. The goal is to ensure that the patient can be moved
on to the next level of care as soon as possible.
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Retrospective Utilization Review
o A review of utilization after services have been delivered
o Review to determine patterns to better assess future patients as
well as ensure that billing was handled appropriately and
accurately.
describe the three utilization review methods used in managed care organizations. Give relevant examples and discuss th...
Identify and describe the three types of utilization reviews of managed care organizations? What are the three main components of a fully developed electronic health record (EHR) according to the Institute of Medicine?
Describe and discuss three methods used to manage utilization during the course of hospitalization be sure to describe and provide examples as a support
Discuss the Utilization Management function in managed care, including Preadmission Certification and Concurrent Review of services.
What are the common characteristics of managed care organizations? Identify and describe the three major types of managed care organization’s remuneration/payment plans to providers?
Compare and contrast each of the three questions related to Managed Care Organizations, Medicare, and Medicaid with one another and explain how they were similar and different to each other. Managed care organizations emphasize physicians' responsibilities to control patient access to expensive hospitalization and specialty care, a principle dubbed "gatekeeping." Some argue that "gatekeeping" is unethical because it introduces financial factors into treatment decisions. Others say it improves quality by promoting the use of the most appropriate levels of care....
Compare and contrast each of the three questions related to Managed Care Organizations, Medicare, and Medicaid with one another and explain how they were similar and different to each other. Managed care organizations emphasize physicians' responsibilities to control patient access to expensive hospitalization and specialty care, a principle dubbed "gatekeeping." Some argue that "gatekeeping" is unethical because it introduces financial factors into treatment decisions. Others say it improves quality by promoting the use of the most appropriate levels of care....
Discuss the three methods of descriptive research (case study, observation, survey). Give examples of each.
Discuss examples in which statistical methods are used, or have been used, in chemical analysis. Identify the statistical methods used, and describe the implementation of these methods as well as the benefits obtained from their use. Explain using f-Test, t-Test, Grub's test, methods in least-squares/linear regression analysis, and multivariate analysis (ANOVA). Do not use methods in principle components analysis (PCA), PCR, Simplex optimization.
Describe the three basic theories for why religion exists , give examples of each, and discuss potential flaws for each. Which theory(s) applies to witchcraft beliefs, and why?
1. Discuss scenarios that contribute to health care organizations assigned as a high, medium, or low formality. 2. Why are codes of conduct relevant, particularly within a health care facility? 3. Identify the physical and technical safeguards the HIPAA Security Rule has deemed necessary for covered entities to be compliant and to communicate securely. Give examples of breaches. How should they have been handled? Do you think the intervention was effective?