Describe components of quality and utilization management

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Reference no: EM131862897

ASSIGNMENT: Managed Healthcare

Directions: Unless otherwise stated, answer in complete sentences, and be sure to use correct English, spelling, and grammar. Sources must be cited in APA format. Your response should be four double-spaced pages; refer to the "Format Requirements" page for specific format requirements.

This writing assignment has two parts and involves the required readings from lessons 5-8.

Part I

For each of the lessons you were presented with two required readings. Choose one required reading article from each lesson and summarize the article and explain its importance to understanding managed care. Each summary should be a minimum of 250 words. Combine all summaries into one Word document.

Part II

Explain why the following course objectives are important to understanding managed care:

5. Describe the basic components of quality and utilization management, including structure, process, and outcome.

6. Identify and describe the basic structure of governance and management in payer organizations.

7. Understand the basic issues involved with Medicare Advantage and managed Medicaid plans.

8. Describe the basic structure of state and federal oversight of managed care organizations (MCOs).

Include at least 3 scholarly articles as a part of your response as well as a minimum word count of 750 words. Overall response will be formatted according to APA style and the total assignment of Part II should be between 3-6 pages, not including title page and reference page.

Articles:

1. What do physicians dislike about managed care? Evidence from a choice experiment by Maurus Rischatsch and Peter Zweifel.

2. Resource use and costs of type 2 diabetes patients receiving managed or protocolized primary care: a controlled clinical trial by Amber AWA van der Heijden, Martine C de Bruijne, Talitha L Feenstra, Jacqueline M Dekker, Caroline A Baan, Judith E Bosmans, Sandra DM Bot, Gé A Donker and Giel Nijpels.

Reference no: EM131862897

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