Relationship between government and managed care

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Reference no: EM13740216

Question 1: How has the relationship between government and managed care evolved over the years? What factors have driven this changing relationship?

Question 2: Describe the preferred provider organization (PPO) model of managed care. Why do you feel that this is the dominant form of managed care today?

Question 3: Why do managed care organizations have a board of directors? What is the function of the board of directors?

Question 4: What is the role of the Peer Review Committee in a managed care organization? And why is this function so crucial?

Question 5: Describe the calculation of capitated payments. How are these rates determined in managed care organizations?

Question 6: Describe the use of evidence-based clinical criteria in managed care. Why is this process so important in managed care today?

Question 7: What is meant by transitional case management (TCM) under managed care? Provide some specific examples of TCM functions.

Question 8: Discuss tools for changing physician behavior. Provide specific examples and perspectives on what will work best for changing behavior.

Question 9: What is the purpose of hold-harmless and balance-billing clauses in managed care contracts?

Question 10: What is the purpose of the declarations in managed care contracts?

Reference no: EM13740216

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